Determinants of practice patterns in pediatric UTI management

Abstract

Summary Introduction Urinary tract infection (UTI) affects 10% of girls and 3% of boys by age 16. Both the American Academy of Pediatrics and National Institute for Health and Clinical Excellence Guidelines recommend urine testing prior to initiation of antibiotic treatment, and the use of local antibiograms to guide empiric antibiotic therapy. Urine culture results not only provide the opportunity to halt empiric therapy if there is no bacterial growth, but also allow for tailoring of broad-spectrum therapy. Additionally, the use of antiobiograms is recommended to improve empiric antibiotic selection based on local resistance patterns. However, execution of guideline recommendations has proven challenging. In order to develop targeted interventions aimed at improving adherence to these guidelines, understanding the barriers that may exist in implementing them is critical. Objectives The present study sought to investigate practice patterns and factors that influence urine testing and antibiogram use in the setting of empiric antibiotic treatment of UTI in children, with the aim of ultimately improvinguo A adherence to UTI management guidelines. Study design A random, national sample of physicians caring for children was surveyed from the American Medical Association Masterfile. Participants were queried regarding practice type, length of time in practice, factors influencing urine testing, urine specimen collection method, and antibiogram utilization. Logistic regression was used to assess factors associated with use of urine testing, bagged specimens, and antibiograms. Results Of respondents who acknowledged contact by surveyors, 47% completed the survey (n=366). Most respondents (84%) obtained urinalysis and culture prior to treatment for UTI. Physicians reported that they would more likely order testing if the specimen were easier to collect (46%) and if results were available immediately (48%). Urine collection by bag was more common in circumcised boys (>30%) compared with girls (20%) and uncircumcised boys (20%) (P=0.02). The most common reasons for collection by bag were parental refusal for (49%) and difficulty with (42%) catheterization. Of the 70% of respondents reporting antibiogram access (n=256), 50% reported its use the majority of the time with empiric prescription (n=128). Discussion While most practitioners reported following guidelines to obtain urine testing prior to antibiotic prescription for UTI, urine collection by bag was common. Additionally, <50% of practitioners adhered to guideline recommendations for empiric antibiotic selection based on local antibiograms. Interventions to improve adherence to UTI management guidelines should focus on: (1) improving catheterization practices; (2) educating parents regarding the value of catheterization; and (3) incorporating local antibiograms into electronic medical records.

Appropriateness of Antibiotic Prescriptions for Urinary Tract Infections

“…In a recent survey of pediatric providers, 70% reported access to local antibiograms and, of these, only 50% reported using the antibiogram "always" or "most of the time" when empirically prescribing antibiotics for UTIs. 10 Prescribing practices for UTIs are variable and problems exist, including the use of overly broad antibiotics and treatment in the absence of true infection. 11,12 To investigate antibiotic prescribing practices for suspected UTIs, we primarily sought to determine whether empiric antibiotic selection was appropriate for suspected UTIs in children and adults.…”

Diagnosis and management of urinary tract infections in children aged 2 months to 3 years in the Italian emergency units: the ItaUTI study

“…For instance, previous surveys among primary care physicians showed that antimicrobials are widely prescribed for outpatient UTI cases without urine culture testing [ 10 , 11 ]. The difficultness associated to the urine collection might, at least in part, explain these findings [ 12 , 13 ].…”

Digital Antimicrobial Stewardship Decision Support to Improve Antimicrobial Management

“…23 Survey data have indicated that house officers, attending physicians, and nurse practitioners across multiple specialties and practice settings express low rates (< 50%) of institutional antibiogram use, instead favoring publicly available general resources such as UpToDate or The Sanford Guide. 22,23,24,25 These resources lack antibiotic recommendations tailored to susceptibility patterns at the regional or institutional level.…”