Use of Urine Testing in Outpatients Treated for Urinary Tract Infection

Copp, Hillary L.; Yiee, Jenny H.; Smith, Alexandria; Hanley, Janet; Saigal, Christopher S.

doi:10.1542/peds.2012-3135

Cited by 21 publications

(18 citation statements)

References 20 publications

(23 reference statements)

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“…9 We chose a 14-day window for antibiotics prescriptions associated with the UTI visit was chosen to allow for delays in claims processing. Antibiotic prescriptions for urinary tract infections were limited to those with less than 30 days supply to exclude prescriptions for antibiotic prophylaxis.…”

Section: Methodsmentioning

confidence: 99%

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Incidence and Management of Uncomplicated Recurrent Urinary Tract Infections in a National Sample of Women in the United States

Suskind

Saigal

Hanley

et al. 2016

Urology

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Objective To determine the incidence and characteristics of women with uncomplicated recurrent UTIs and to explore whether the use of culture-driven treatment affects rates of UTI-related complications and resource utilization. Methods Using MarketScan claims from 2003 to 2011, we identified UTI naive women ages 18–64 with incident uncomplicated recurrent UTIs. Recurrent UTIs were defined as 3 UTI visits associated with antibiotics during a 12-month period. Cases were excluded if they had a UTI in the preceding year, or if they had any complicating factors (e.g. abnormality of the urinary tract, neurologic condition, pregnancy, diabetes, or currently taking immunosuppression). We next assessed use of urine cultures, imaging, and cystoscopy and performed propensity score matching with logistic regression to determine whether having a urine culture associated with >50% of UTIs affected rates of complications and downstream resource utilization. Results We identified 48,283 women with incident uncomplicated recurrent UTIs, accounting for an overall incidence of 102 per 100,000 women, highest among women ages 18–34 and 55–64. 61% of these women had at least 1 urine culture, 6.9% had imaging, and 2.8% had cystoscopy. Having a urine culture >50% of the time was associated with fewer UTI-related hospitalizations and lower rates of IV antibiotic use, while demonstrating higher rates of UTI-related office visits and pyelonephritis. Conclusions The incidence of uncomplicated recurrent UTIs increases with age. Urine culture directed care is beneficial in reducing high cost services including UTI related hospitalizations and IV antibiotic use, making them a valuable component to management of these patients.

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Section: Methodsmentioning

confidence: 99%

“…Antibiotic prescriptions for urinary tract infections were limited to those with less than 30 days supply to exclude prescriptions for antibiotic prophylaxis. 9 …”

Section: Methodsmentioning

confidence: 99%

Incidence and Management of Uncomplicated Recurrent Urinary Tract Infections in a National Sample of Women in the United States

Suskind

Saigal

Hanley

et al. 2016

Urology

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“…Although practitioners reported that they obtained urine testing prior to empiric treatment of UTI with antibiotics, this was contrary to the findings of two large studies using claims data, which demonstrated that less than one third of children <3 years had urine testing prior to antibiotic treatment [1,5]. This discrepancy between practitioners’ intentions to obtain urine testing, which was documented in the present study, and the limited rates of urine testing truly obtained, as assessed by Copp et al and Platt et al, suggests that the lack of urine testing seen in practice may not be due to a failure of guideline dissemination or comprehension.…”

Section: Discussionmentioning

confidence: 85%

“…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 with two large studies, which demonstrated that less than one third of children <3 years had urine testing prior to antibiotic treatment [1,5]. …”

Section: Introductionmentioning

confidence: 99%

Determinants of practice patterns in pediatric UTI management

Selekman

Allen

Copp

2016

Journal of Pediatric Urology

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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.

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“…Studies have shown that febrile UTI's represent the most common type of complication in young patients diagnosed with bronchiolitis patients and are particularly common in infants with bronchiolitis (positive RSV culture with symptoms) (7-10). The current AAP guidelines on bronchiolitis recommend treating only patients with symptoms for concurrent UTI and bronchiolitis (11). Based on these studies, we suggest a preoperative culture within 30 days of surgery for patients under 2 years of age with a history of bronchiolitis.…”

Section: Discussionmentioning

confidence: 96%

Is There a Role for Prophylactic Antibiotics Post Pediatric Pyeloplasty?

Sheth

Puttmann

Nichols

et al. 2020

Preprint

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Background: The use of postoperative prophylactic antibiotics in pediatric upper urinary tract reconstruction remains controversial. In this study, we elected to examine if prophylactic antibiotics post pediatric dismember pyeloplasty reduce the incidence of clinically symptomatic urinary tract infections (UTIs) in our institution. As a secondary outcome, we also examine which patient population benefits the most from low dose prophylactic antibiotics.Methods: Institutional review board approval (IRB) was obtained. A retrospective study was performed in patients who underwent dismember pyeloplasty (2011-2017) at our institution. Patients with prior history of urologic interventions or other abnormalities of the genitourinary tract were excluded. Demographics (age, gender, ethnicity, insurance status), prior history of culture proven UTIs, surgical details (administration of perioperative antibiotics), and postoperative outcomes, including any readmission 30 days post repair, any urine samples, and culture results were collected.Results: 209 patients (149 boys, 60 girls) met our inclusion criteria. The average age was 6 years (range: 2 months-18 years). 160 patients (77%) underwent robotic-assisted pyeloplasty. Thirty-one patients underwent open repair (15%). 176 (84%) had an indwelling ureteral stent. Eleven patients (5%) had a culture-proven febrile UTI within 30-days postoperatively. No significant differences were seen in postoperative complications or incidence of UTIs when comparing surgical approaches, ureteral stent, or the use of prophylactic post-operative antibiotics. Secondary review of patients with post-operative febrile UTIs noted younger age (2.8 v. 6.2 years, p = 0.02) and positive intraoperative urine culture (p = 0.01) as significant risk factors. Conclusion: The incidence of postoperative UTIs in our cohort is relatively low. There is a higher incidence of febrile UTIs in patients less than 3 years old and those with positive intraoperative urine culture. The use of prophylactic antibiotics in patients post dismember pyeloplasty did not appear to affect the incidence of febrile culture proven UTIs, however, might be important in younger patients pre potty training.

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Use of Urine Testing in Outpatients Treated for Urinary Tract Infection

Cited by 21 publications

References 20 publications

Incidence and Management of Uncomplicated Recurrent Urinary Tract Infections in a National Sample of Women in the United States

Incidence and Management of Uncomplicated Recurrent Urinary Tract Infections in a National Sample of Women in the United States

Determinants of practice patterns in pediatric UTI management

Is There a Role for Prophylactic Antibiotics Post Pediatric Pyeloplasty?

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