Treatment of UTIs in Infants &amp;lt;2 Months: A Living Systematic Review

Nama, Nassr; Donken, Robine; Pawliuk, Colleen; Leache, Leire; Sadarangani, Manish; Carwana, Matthew

doi:10.1542/hpeds.2021-005877

Cited by 9 publications

(2 citation statements)

References 44 publications

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“…4 For instance, in infants with bacteremic UTI, outcomes are generally excellent despite a wide range in length of stay and duration of parenteral antibiotics. [17][18][19] Additional studies on CAP found that increased resource utilization including blood culture collection, leads to longer length of stay, with no data to support improved benefit. 20,21 Numerous studies, including several recent Pediatric Health Information System database studies, reveal high blood culture collection rates among these three diagnoses, with significant variability noted across hospitals.…”

Section: Introductionmentioning

confidence: 99%

“… 4 For instance, in infants with bacteremic UTI, outcomes are generally excellent despite a wide range in length of stay and duration of parenteral antibiotics. 17 – 19 Additional studies on CAP found that increased resource utilization including blood culture collection, leads to longer length of stay, with no data to support improved benefit. 20 , 21 …”

Section: Introductionmentioning

confidence: 99%

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Decreasing Blood Culture Collection in Hospitalized Patients with CAP, SSTI, and UTI

Combs,

Liberman,

Lee

2023

Pediatric Quality &Amp; Safety

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Background: Blood culture collection in pediatric patients with community-acquired pneumonia (CAP), skin and soft tissue infections (SSTI), and urinary tract infections (UTI) remains high despite evidence of its limited utility. We aimed to decrease the number of cultures collected in children hospitalized for CAP, SSTI, and UTI by 25% over 11 months. Methods: Quality improvement initiative at a children’s hospital among well-appearing patients aged 2 months or more to 18 years diagnosed with CAP, SSTI, or UTI. Our primary and secondary outcomes were blood culture collection rate and positivity rate, respectively. Interventions focused on three key drivers: academic detailing, physician awareness of personal performance, and data transparency. Results: Over the 2-year study period, there were 105 blood cultures collected in 223 hospitalized patients. Blood culture collection rates demonstrated special cause variation, decreasing from 63.5% to 24.5%. For patients with UTI, 86% (18/21) of blood cultures were negative, whereas 100% were negative for CAP and SSTI. All three patients with bacteremic UTI had a concurrent urine culture growing the same pathogen. Balancing measures remained unchanged, including escalation to a higher level of care and return to the emergency department or hospital within 14 days for the same infection. Conclusions: A multifaceted quality improvement approach can reduce blood culture collection for hospitalized patients with CAP, SSTI, and UTI without significant changes to balancing measures. Despite the reduction achieved, the near-universal negative culture results suggest continued overutilization and highlight the need for more targeted approaches to blood culture collection.

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