Related Experiment Video
Updated: Jun 29, 2025
Recurrent Escherichia coli Urinary Tract Infection Triggered by Gardnerella vaginalis Bladder Exposure in Mice
Published on: December 4, 2020
Improving Adherence to Evidence-based Practice for Uncomplicated UTI in a Pediatric Emergency Department
Jaclyn N Kline1,2, Lauren N Powell1,3, Jonathan D Albert1,3
1From the George Washington University School of Medicine & Health Sciences, Washington, D.C.
Insights
This study improved pediatric uncomplicated urinary tract infection (uUTI) treatment by increasing 3-day antibiotic courses and cephalexin use. An order set intervention successfully enhanced adherence to evidence-based guidelines without adverse events.
Area of Science:
- Pediatric infectious diseases
- Antimicrobial stewardship
- Quality improvement science
Background:
- Uncomplicated urinary tract infections (uUTIs) are common pediatric bacterial infections with significant variability in treatment duration and antibiotic choice.
- Optimizing uUTI treatment is crucial for effective care and preventing antibiotic resistance.
Purpose of the Study:
- To improve adherence to a 3-day antibiotic treatment course for pediatric uUTI in children over 24 months.
- To increase the selection of cephalexin as the preferred antibiotic for pediatric uUTI.
Main Methods:
- A single-center quality improvement study was conducted from March 2021 to March 2022, including 1,435 pediatric patients.
- An order set with embedded discharge prescriptions was implemented, supported by education and provider feedback.
- Key outcome measures included the percentage of children receiving 3-day antibiotic treatment and cephalexin prescription rates.
Main Results:
- Rates of 3-day antibiotic prescriptions for uUTI increased significantly from 3% to 44%.
- Cephalexin prescription rates for uUTI rose from 49% to 74%.
- Order set utilization improved from 0% to 49%, with no significant change in 7-day emergency department revisits.
Conclusions:
- The quality improvement initiative successfully enhanced the use of shorter antibiotic courses and cephalexin for pediatric uUTI.
- Implementation of an order set with integrated discharge prescriptions proved effective in achieving treatment guideline adherence.
- The intervention demonstrated improved clinical practice without negative impacts on patient safety, as indicated by emergency department revisit rates.
Introduction:
Uncomplicated urinary tract infections (uUTIs) are among the more common pediatric bacterial infections. Despite their prevalence, significant variability exists in the treatment duration and antibiotic selection for uUTI. Our first aim was to improve adherence to a three-day course of antibiotic treatment for uUTI in children over 24 months old. Our second aim was to increase the selection of cephalexin in this population.
Methods:
We conducted a single-center quality improvement study from March 2021 to March 2022. One thousand four hundred thirty-five patients were included across our baseline and intervention periods. We created an order set with embedded discharge prescriptions and followed this with education and provider feedback. The outcome measures for this study were percent of children receiving 3 days of antibiotic treatment and percent of children prescribed cephalexin. In addition, we tracked order set use as a process measure, and 7-day emergency department revisit as a balancing measure.
Results:
Rates of 3-day prescriptions for uUTI demonstrated special cause variation with an increase from 3% to 44%. Prescription rates of cephalexin for uUTI demonstrated special cause variation with an increase from 49% to 74%. The process measure of order set use improved from 0% to 49% after implementation. No change occurred in 7-day emergency department revisits.
Conclusion:
We demonstrated improved use of shorter course therapy for uUTI with a first-generation cephalosporin throughout this project without adverse events. We leveraged an order set with embedded discharge prescriptions to achieve our goals.
