MP53-06 SPINA BIFIDA-SPECIFIC CRITERIA FOR UTI DIAGNOSIS REFLECT ONLY A SUBSET OF EMPIRIC ANTIBIOTIC USE AMONG CHILDREN WITH SPINA BIFIDA SEEN IN THE EMERGENCY DEPARTMENT

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You have accessJournal of UrologyCME1 Apr 2023MP53-06 SPINA BIFIDA-SPECIFIC CRITERIA FOR UTI DIAGNOSIS REFLECT ONLY A SUBSET OF EMPIRIC ANTIBIOTIC USE AMONG CHILDREN WITH SPINA BIFIDA SEEN IN THE EMERGENCY DEPARTMENT Victor M. Kucherov, Teresa L. Russell, Jacob C. Smith, Sally Zimmermann, Elena K. Johnston, M. Sohel Rana, Elaise Hill, Christina P. Ho, Hans G. Pohl, and Briony K. Varda Victor M. KucherovVictor M. Kucherov More articles by this author , Teresa L. RussellTeresa L. Russell More articles by this author , Jacob C. SmithJacob C. Smith More articles by this author , Sally ZimmermannSally Zimmermann More articles by this author , Elena K. JohnstonElena K. Johnston More articles by this author , M. Sohel RanaM. Sohel Rana More articles by this author , Elaise HillElaise Hill More articles by this author , Christina P. HoChristina P. Ho More articles by this author , Hans G. PohlHans G. Pohl More articles by this author , and Briony K. VardaBriony K. Varda More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003301.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Spina bifida (SB)-specific criteria for urinary tract infection (UTI) diagnosis are stricter than those for the general pediatric population in effort to avoid overtreatment. It is unknown how closely these criteria are followed in the emergency department (ED) setting. The objective of this study was to examine the clinical factors associated with initiation of empiric antibiotics for UTI in children with SB seen in the ED. METHODS: A single-institution retrospective database of children with SB (age <21 years) presenting to the ED between 2016 and 2020 was queried. Only encounters with urinalysis (UA) performed were included. The primary outcome was initiation of empiric antibiotics for UTI. Covariables included baseline patient and clinical characteristics. Specific urologic presenting symptoms (fever ≥38°C, abdominal/flank/urethral pain, malodorous/cloudy urine, urinary incontinence) and components of the UA (pyuria [>10 WBC/hpf], nitrites, turbidity, identification of bacteria) were collected. Proportion of patients meeting previously published SB-specific criteria for UTI in the pre-culture setting (≥2 urologic symptoms plus pyuria) were examined. Analysis included descriptive statistics and examining the association between presenting factors with use of empiric antibiotics using multivariable logistic regression. RESULTS: Out of 1,487 encounters, 299 were included comprising 92 unique patients (median 2 encounters per patient, range 1 - 22). Median encounter age was 8 years (range 0.04 – 20). Patients were majority female (60%), Hispanic (55%), and had a myelomeningocele (72%) with supra-sacral lesion (77%). Empiric antibiotics for UTI were initiated in 56%. Only 36% of those receiving antibiotics met SB-specific criteria. Among those receiving antibiotics pyuria was the most common UA finding (88%). When adjusting for covariables, antibiotic use was associated with fever (OR 2.9), cloudy urine (OR 6.5) and the following individual UA components: pyuria (OR 11), nitrites (OR 4.4), urine turbidity (OR 3.5), and bacteria (OR 2.1) (all p<0.05). CONCLUSIONS: Antibiotics were given to about half of children with SB presenting to the ED when a UA was obtained. Receipt of antibiotics was associated with fever and cloudy urine. Among the UA components, pyuria had the strongest association. Only about one third of those receiving antibiotics met the combination of SB-specific criteria for a UTI diagnosis, raising concern for overuse of empiric antibiotics in this population. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e714 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Victor M. Kucherov More articles by this author Teresa L. Russell More articles by this author Jacob C. Smith More articles by this author Sally Zimmermann More articles by this author Elena K. Johnston More articles by this author M. Sohel Rana More articles by this author Elaise Hill More articles by this author Christina P. Ho More articles by this author Hans G. Pohl More articles by this author Briony K. Varda More articles by this author Expand All Advertisement PDF downloadLoading ...