The prevalence of empiric antibiotic use in an emergency department on children with suspected urinary tract infections: A retrospective study in Saudi Arabia

Abstract

Objectives: The prescription of antibiotics for suspected urinary tract infection (UTI) is common practice and may result in unnecessary antibiotic exposure. Our goal was to review the diagnosis and management of UTI in an emergency department and to determine the goals of antimicrobial stewardship. Methods: This is a single-centre, retrospective study that was conducted among children aged between 12 months and 18 years old who had been discharged from the emergency department with a diagnosis of UTI in the period between January and August 2022. Clinical information, laboratory findings, urine collection methods and urine culture results as well as details of prescribed antibiotics were gathered. The relation between urinalysis characteristics and confirmed UTI was assessed as a secondary outcome of the study. Results: In this study, we were able to collect data for 183 children with a mean age of 4.2 (1.1-7.5) years and 82.5% of them were girls. Almost all children with UTI were discharged to home with prescribed antibiotics (98%) for a median duration of seven days ranging between 7-10 days. Among those who used antibiotics, 46.4% of the patients had negative urine cultures, resulting in 525 unnecessary antibiotic prescriptions. Presence of nitrite in the urine was the strongest and highly specific predictor of UTI (odds ratio of 20.22, P< 0.001). Conclusions: Current practice in the management of suspected pediatric urinary tract infections in the selected emergency department resulted in significant and unnecessary exposure to antibiotics. We set goals to reduce unnecessary antibiotic exposure, including improving the accuracy of UTI diagnosis, establishing a process to discontinue antibiotic consumption for negative cultures, and standardizing the duration of antimicrobials. Keywords: urinary tract infections, pediatrics, children, antimicrobial monitoring, urinalysis, antibiotics, empiric use, E. coli, nitrite, urine culture.