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Variability in Treatment of UTIs in Children With Genitourinary Anomalies in Children's Hospitals
Catherine S Forster1, Alexis C Wood2, Stephanie Davis-Rodriguez3
1Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania.
Insights
Children's hospitals show varied antibiotic treatments for urinary tract infections (UTIs) in kids with urinary tract anomalies. Despite treatment differences, emergency department return visits remained similar across hospitals.
Area of Science:
- Pediatric Nephrology
- Infectious Diseases
- Health Services Research
Background:
- Febrile urinary tract infections (UTIs) pose risks like sepsis and kidney injury in children with urinary tract anomalies.
- Optimal antibiotic treatment strategies for this vulnerable pediatric population remain undefined.
- Understanding current treatment variations is crucial for improving care quality.
Purpose of the Study:
- To describe antibiotic treatment practices for UTIs in children with urinary tract anomalies.
- To evaluate outcomes associated with these UTIs, including hospitalization and emergency department (ED) revisits.
- To assess variability in UTI treatment approaches across different children's hospitals.
Main Methods:
- A multicenter retrospective cohort study involving 510 children (0-17 years) diagnosed with febrile or hypothermic UTI.
- Data collected from 6 US children's hospitals between January 2017 and December 2018.
- Analysis included intravenous antibiotic administration, hospitalization rates, length of stay, and ED return visits, with multivariable regression adjusting for patient characteristics.
Main Results:
- Significant site-based variations were observed in IV antibiotic administration timing, spectrum, and duration.
- Hospital length of stay also differed significantly between sites.
- No significant differences were found in bacteremia rates, intensive care unit stays, or 30-day ED return visits across hospitals.
Conclusions:
- Children's hospitals exhibit considerable variability in treating UTIs among children with urinary tract anomalies.
- Despite treatment practice differences, ED revisit rates were consistent across sites.
- This highlights an opportunity to standardize and promote high-value care for UTIs in this pediatric group.
Objective:
In children with urinary tract anomalies, febrile urinary tract infections (UTIs) are associated with increased risks of sepsis, hospitalization, and kidney injury. However, the best treatment strategies are unknown. We aimed to describe antibiotic treatment practices and outcomes for UTIs in children with urinary tract anomalies and evaluate whether variability in UTI treatment exists between hospitals.
Methods:
We conducted a multicenter retrospective cohort study of children seen in emergency departments (EDs) in 6 free-standing US children's hospitals from January 1, 2017, through December 31, 2018. We included children aged 0-17 years with an anatomic or functional urinary tract anomaly and a physician diagnosis of febrile or hypothermic UTI. Outcomes included intravenous (IV) antibiotic administration practices, hospitalization rates, length of stay, and return ED visits. Multivariable logistic and linear regression were performed, adjusting for differences in patient and illness characteristics.
Results:
Among the 510 children included, anomaly types, presence of home catheterization regimens, and baseline glomerular filtration rates varied between sites. In the adjusted analyses, sites differed in several treatment practices: IV antibiotic administration before ED discharge (P = .007), IV antibiotic spectrum (P = .003), IV antibiotic duration (P < .001), and hospital length of stay (P < .001). No statistically significant differences existed with bacteremia (P = .24) or intensive care stays (P = .08). Returns to the ED within 30 days did not significantly differ by site (P = .68).
Conclusions:
Children's hospitals vary in their treatment of UTIs in children with urinary tract anomalies, yet ED revisits are similar across sites, highlighting the opportunity to promote high-value care in treatment of UTIs in this population.
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