Improving Antibiotic Management for Pediatric Patients Diagnosed With Presumed Urinary Tract Infections in the...

The objective of this quality improvement (QI) study was to increase appropriate antibiotic management for presumed urinary tract infection (UTI) based on urine culture results for patients discharged from the pediatric emergency department (ED) to 90% (from a baseline of 61%) over 12 months.

Pediatric patients discharged from our pediatric ED from February 2024 to January 2025 with the diagnosis of cystitis, pyelonephritis, or UTI were included in our study. We excluded patients with chronic urologic or renal anomalies, immunocompromised status, or those on antibiotics before ED presentation. The primary outcome was the percentage of patients appropriately managed based on urine culture results. Interventions tested using Plan, Do, Study, Act cycles included provider education, individualized antimicrobial stewardship program (ASP) feedback, clinical guideline creation and implementation, and electronic health record (EHR) enhancements. Our balancing measure was ED revisit within 7 days with persistent UTI symptoms.

A total of 355 encounters were included in the intervention period. Mean percentage of patients appropriately managed increased from 61% to 92%. Immediately following our education of the ED team, we observed special cause variation and shifted our centerline. Our second shift was attributed to the implementation of a guideline and EHR enhancements. Guideline adherence was 98%. Four patients (1.1%) returned to the ED within 7 days with persistent UTI symptoms but were found to have other diagnoses.

This QI project demonstrated that provider education, guideline implementation, and individualized ASP feedback can improve antibiotic management of pediatric patients with UTI discharged from the pediatric ED.