623 URINE CULTURE UTILIZATION AND BROAD-SPECTRUM ANTIBIOTIC PRESCRIPTION FOR PEDIATRIC URINARY TRACT INFECTION: GUIDELINES VERSUS PRACTICE PATTERNS

Abstract

You have accessJournal of UrologyPediatrics: Imaging (Genital & Urinary Tract)/Infections and Vesicoureteral Reflux1 Apr 2012623 URINE CULTURE UTILIZATION AND BROAD-SPECTRUM ANTIBIOTIC PRESCRIPTION FOR PEDIATRIC URINARY TRACT INFECTION: GUIDELINES VERSUS PRACTICE PATTERNS Hillary Copp, Jenny Yiee, Alexandria Smith, Janet Hanley, Christopher Saigal, Urologic Diseases in America, and Urologic Diseases in Americab Hillary CoppHillary Copp San Francisco, CA More articles by this author , Jenny YieeJenny Yiee Los Angeles, CA More articles by this author , Alexandria SmithAlexandria Smith Santa Monica, CA More articles by this author , Janet HanleyJanet Hanley Santa Monica, CA More articles by this author , Christopher SaigalChristopher Saigal Los Angeles, CA More articles by this author , Urologic Diseases in AmericaUrologic Diseases in America Los Angeles, CA More articles by this author , and Urologic Diseases in Americab More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.701AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Broad-spectrum antibiotics are frequently prescribed in the outpatient treatment of pediatric urinary tract infection (UTI). As a key step in decreasing the emergence of antimicrobial resistance the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America recommend tailoring of empiric antibiotic therapy based on urine culture results. No study has characterized the concurrent use of urine cultures with empiric broad-spectrum antibiotic prescription in the treatment of pediatric UTI. METHODS We used Innovus i3, a claims database with longitudinal data from 2002-2007. We examined children <18 years who had a broad-spectrum antibiotic prescribed for an outpatient UTI. Amoxicillin-clavulanate, quinolones, macrolides, and second- and third-generation cephalosporins were classified as broad-spectrum antibiotics. We evaluated trends in obtaining urine cultures with broad-spectrum prescription and performed multivariable logistic regression to assess for factors associated with obtaining a urine culture with broad-spectrum prescription for UTI. RESULTS Urine culture was performed in 62% of the 10,318 UTI visits for which a broad-spectrum antibiotic was prescribed. The proportion of urine cultures obtained among broad-spectrum UTI visits decreased during the study period from 67% to 58% (p<0.001). On multivariable analysis age (2-5 years: OR 1.3, 95%CI 1.1-1.5 and 6-12 years: OR 1.4, 95%CI 1.2-1.6 compared with age 13-17 years); history of UTI (OR 1.1, 95%CI 1.0-1.2); presence of congenital urologic anomaly (OR 1.2, 95%CI 1.0-1.4); and physician specialty (pediatricians: OR 2.4, 95%CI 2.2-2.7 compared with family physicians/internists) were independent predictors of performing a urine culture with broad-spectrum antibiotic prescription. Males (OR 0.8, 95%CI 0.7-0.9) and patients from the Northeast (OR 0.8, 95%CI 0.7-0.9), Midwest (OR 0.9, 95%CI 0.8-0.9), and West (OR 0.7, 95%CI 0.6-0.8) compared with the South were less likely to have urine cultures obtained when prescribed broad-spectrum antibiotics. CONCLUSIONS Providers often do not obtain urine cultures when prescribing broad-spectrum antibiotics and the occurrence of this practice has decreased overtime. Important differences in practice patterns were observed based on patient sex, geographic location, and physician specialty. These findings support the need for interventions to promote guideline-based practices for empiric broad-spectrum antibiotic treatment of pediatric UTI. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e253 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hillary Copp San Francisco, CA More articles by this author Jenny Yiee Los Angeles, CA More articles by this author Alexandria Smith Santa Monica, CA More articles by this author Janet Hanley Santa Monica, CA More articles by this author Christopher Saigal Los Angeles, CA More articles by this author Urologic Diseases in America Los Angeles, CA More articles by this author Urologic Diseases in Americab More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...