Clinical and Demographic Factors Associated With Urinary Tract Infection in Young Febrile Infants

Zorc, Joseph J.; Levine, Deborah A.; Platt, Simon R.; Dayan, Peter; Macias, Charles G.; Krief, William; Schor, Jeffrey A.; Bank, David; Shaw, Kathy N.; Kuppermann, Nathan

doi:10.1542/peds.2004-1825

Cited by 235 publications

(154 citation statements)

References 28 publications

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“…[10][11][12] Race was dichotomized into white versus nonwhite and insurance status was categorized into private versus nonprivate because of sample size limitations. Private insurance included those with health maintenance organization and preferred provider organization coverage.…”

Section: Measurementsmentioning

confidence: 99%

National Ambulatory Antibiotic Prescribing Patterns for Pediatric Urinary Tract Infection, 1998–2007

Copp¹,

Shapiro

Hersh

2011

Pediatrics

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WHAT'S KNOWN ON THIS SUBJECT:Urinary tract infections represent a significant source of exposure to antibiotics in the pediatric population and often physicians must select the antibiotic treatment empirically. No examination of ambulatory antibiotic prescribing patterns in the United States for children with urinary tract infections has been performed. WHAT THIS STUDY ADDS:Ambulatory care physicians commonly prescribe broad-spectrum antibiotics, especially third-generation cephalosporins, for the treatment of pediatric urinary tract infections. Given that narrower-spectrum alternatives are frequently appropriate options for the treatment of these infections, efforts are necessary to promote more judicious antibiotic prescribing for pediatric urinary tract infections.abstract OBJECTIVE: The goal of this study was to investigate patterns of ambulatory antibiotic use and to identify factors associated with broad-spectrum antibiotic prescribing for pediatric urinary tract infections (UTIs). METHODS:We examined antibiotics prescribed for UTIs for children aged younger than 18 years from 1998 to 2007 using the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey. Amoxicillin-clavulanate, quinolones, macrolides, and second-and third-generation cephalosporins were classified as broad-spectrum antibiotics. We evaluated trends in broad-spectrum antibiotic prescribing patterns and performed multivariable logistic regression to identify factors associated with broad-spectrum antibiotic use. RESULTS: Antibiotics were prescribed for 70% of pediatric UTI visits. Trimethoprim-sulfamethoxazole was the most commonly prescribed antibiotic (49% of visits). Broad-spectrum antibiotics were prescribed one third of the time. There was no increase in overall use of broadspectrum antibiotics (P ϭ .67); however, third-generation cephalosporin use doubled from 12% to 25% (P ϭ .02). Children younger than 2 years old (odds ratio: 6.4 [95% confidence interval: 2.2-18.7, compared with children 13-17 years old]), females (odds ratio: 3.6 [95% confidence interval: 1.6 -8.5]), and temperature Ն100.4°F (odds ratio: 2.9 [95% confidence interval: 1.0 -8.6]) were independent predictors of broadspectrum antibiotic prescribing. Race, physician specialty, region, and insurance status were not associated with antibiotic selection. CONCLUSIONS: Ambulatory care physicians commonly prescribe broad-spectrum antibiotics for the treatment of pediatric UTIs, especially for febrile infants in whom complicated infections are more likely. The doubling in use of third-generation cephalosporins suggests that opportunities exist to promote more judicious antibiotic prescribing because most pediatric UTIs are susceptible to narrower alternatives. To our knowledge, no previous study has examined ambulatory antibiotic prescribing patterns in the United States for children with UTIs. Studies in the adult literature have demonstrated an increase in the use of broad-spectrum antibiotics for UTIs, 4-6 raising concerns that unnecessar...

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Section: Measurementsmentioning

confidence: 99%

National Ambulatory Antibiotic Prescribing Patterns for Pediatric Urinary Tract Infection, 1998–2007

Copp¹,

Shapiro

Hersh

2011

Pediatrics

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“…Pyonephritis is seen in 34-70% of those with febrile UTI, (62) where UTI is the cause of the fever in 21% of uncircumcised boys, 2% of circumcised boys and 5% of girls. (63) An imaging study found that 50-86% of children admitted with febrile UTI and presumed pyelonephritis had renal parenchymal defects. (64) These persist, and a 27-year follow-up study found elevated risk of hypertension and endstage renal disease in 10%, (65) meaning ongoing morbidity and costs from an infant UTI.…”

Section: Penile Cancermentioning

confidence: 99%

Why circumcision is a biomedical imperative for the 21^stcentury

Morris

2007

BioEssays

101

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Circumcision of males represents a surgical “vaccine“ against a wide variety of infections, adverse medical conditions and potentially fatal diseases over their lifetime, and also protects their sexual partners. In experienced hands, this common, inexpensive procedure is very safe, can be pain‐free and can be performed at any age. The benefits vastly outweigh risks. The enormous public health benefits include protection from urinary tract infections, sexually transmitted HIV, HPV, syphilis and chancroid, penile and prostate cancer, phimosis, thrush, and inflammatory dermatoses. In women circumcision of the male partner provides substantial protection from cervical cancer and chlamydia. Circumcision has socio‐sexual benefits and reduces sexual problems with age. It has no adverse effect on penile sensitivity, function, or sensation during sexual arousal. Most women prefer the circumcised penis for appearance, hygiene and sex. Given the convincing epidemiological evidence and biological support, routine circumcision should be highly recommended by all health professionals. BioEssays 29:1147–1158, 2007. © 2007 Wiley Periodicals, Inc.

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“…Изолированная пиурия, бактериурия или положи-тельный нитратный тест у детей до 6 мес не являются достоверными признаками инфекции мочевыводящих путей [20][21][22][23][24][25][26].…”

Section: диагностика инфекции мочевыводящих путейunclassified

Urinary Tract Infection in Children

Маргиева¹,

Komarova²,

Костюшина³

et al. 2014

Pediatr. farmakol.

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путей, этиология, патогенез, клинические проявления, диагностика, лейкоцитурия, бактериурия, сбор мочи, лечение, антибактериальная терапия, профилактика, прогноз, новорожден-ные, младенцы, дети. (Педиатрическая фармакология. 2014; 11 (4): 124-128) Urinary Tract Infection in Children ВВЕДЕНИЕИнфекции мочевыводящих путей (ИМВП) -ведущая причина тяжелых бактериальных инфекций у младен-цев; наблюдаются у 7% детей младше 6 мес жизни и у 5% в возрасте от 6 до 24 мес [1]. ИМВП в период детства переносят в среднем до 10% девочек и 3% маль-чиков. Пузырно-мочеточниковый рефлюкс (ПМР) выяв-ляют после эпизода ИМВП, особенно у новорожденных и младенцев (в 36-49% случаев). В возрасте до 6 мес не наблюдается различий в частоте встречаемости ПМР у мальчиков и девочек [2,3]. ИМВП делят на осложнен-ные, протекающие с лихорадкой (чаще всего пиелонеф-рит), и неосложненные -без лихорадки (чаще инфек-ция нижних мочевыводящих путей). ЭТИОЛОГИЯ И ПАТОГЕНЕЗСреди возбудителей инфекций мочевыводящих путей у детей преобладает грамотрицательная фло-ра, при этом около 90% приходится на инфицирова-ние бактериями Escherichia coli. Грамположительные

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Clinical and Demographic Factors Associated With Urinary Tract Infection in Young Febrile Infants

Abstract: Being uncircumcised and height of fever were associated with UTI in febrile infants who were < or =60 days of age. Uncircumcised male infants were at particularly high risk and may warrant a different approach to screening and management.

Cited by 235 publications

References 28 publications

National Ambulatory Antibiotic Prescribing Patterns for Pediatric Urinary Tract Infection, 1998–2007

National Ambulatory Antibiotic Prescribing Patterns for Pediatric Urinary Tract Infection, 1998–2007

Why circumcision is a biomedical imperative for the 21^stcentury

Urinary Tract Infection in Children

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Clinical and Demographic Factors Associated With Urinary Tract Infection in Young Febrile Infants

Abstract: Being uncircumcised and height of fever were associated with UTI in febrile infants who were < or =60 days of age. Uncircumcised male infants were at particularly high risk and may warrant a different approach to screening and management.

Cited by 235 publications

References 28 publications

National Ambulatory Antibiotic Prescribing Patterns for Pediatric Urinary Tract Infection, 1998–2007

National Ambulatory Antibiotic Prescribing Patterns for Pediatric Urinary Tract Infection, 1998–2007

Why circumcision is a biomedical imperative for the 21stcentury

Urinary Tract Infection in Children

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Product

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Why circumcision is a biomedical imperative for the 21^stcentury