543 - Antibiotic Stewards?: Prescribing Patterns in Emergency Department Pediatric Urinary Tract Infections

Poster Number: 543
Publication Number: 543.328

Jasmine Dillard, Cleveland Clinic Children's, Cleveland, OH, United States; Heather L. Daniels, Cleveland Clinic Children's, Cleveland, OH, United States; Kaitlyn Rivard, Cleveland Clinic, Cleveland, OH, United States; Sarah Worley, Cleveland Clinic Children's, Cleveland, OH, United States; Onyinyechi I. Ukwuoma, UH Rainbow Babies & Children's Hospital, Cleveland, OH, United States

Background: Urinary tract infections (UTIs) are frequently encountered in children, with up to 7% of children experiencing a UTI by age 19 (Mahony, 2019). Timely diagnosis and treatment are essential as 3-15% develop renal parenchymal scarring within two years of the first diagnosed febrile UTI which may lead to complications such as hypertension, chronic kidney disease, and the need for renal transplantation (Jayaweera, 2018; Kutasy, 2017). Targeted antibiotic therapy is necessary to prevent such outcomes and is complicated by the resurgence of multidrug resistant organisms (MDRO). Based on recent CDC data, there are over 2.8 million antibiotic resistant infections each year linked to over 35,000 deaths annually (CDC, 2019).

Objective: To review antibiotic usage for UTIs in our community Pediatric Emergency Department (ED) during 2019. We specifically analyzed how often first line antibiotics based on local antibiogram data (i.e. 1st generation cephalosporins) were empirically prescribed versus non-first line antibiotics.

Design/Methods: We retrospectively reviewed pediatric patients aged 6 months to 12 years diagnosed with complicated and uncomplicated urinary tract infections, including pyelonephritis in the ED using the Antimicrobial Use Registry and Ambulatory Antibiotics Dashboard.

Results: We identified 691 subjects with 719 UTI episodes. Overall, cephalexin was empirically prescribed in 443 (62%) of these episodes while non-first line antibiotics were prescribed in 276 (38%) episodes. In patients receiving cephalexin, 3 (0.8%) required adjustment in empiric therapy based on urine culture sensitivity results compared to 16 (7%) receiving non-first line antibiotics (p < 0.001). Thirty-one (11%) UTI episodes treated with non-first line antibiotics were considered complicated requiring further intervention versus 27 (6%) of UTI episodes treated with cephalexin (p=0.015). Ultimately, of 603 obtained cultures, only 151 (25%) UTI episodes were considered positive with >100,000 colony forming units (CFUs)/ mL of an organism identified.Conclusion(s): Use of non-first line empiric therapy is linked to increased interventions and the need for antibiotic adjustment after urine culture sensitivity results. The use of broad-spectrum antibiotics is unnecessary based on local resistance patterns and perpetuates the prevalence of MDROs. Future work should focus on the importance of obtaining urine cultures in all subjects with suspected UTIs as well as swiftly discontinuing antibiotics based on final urine culture results to prevent unnecessary antibiotic exposure and improve antibiotic stewardship.
Dillard CVJasmine Dillard 2021 PAS CV.pdf
Complications by Antibiotic11% (31/276) of UTI episodes treated with non-first line antibiotics were considered complicated or requiring further intervention vs 6% (27/443) of UTI episodes treated with cephalexin (p=0.015). Complications included development of renal abscess, recurrent infection, need for hospitalization for outpatient management failure, infectious disease consult, nephrology consult, urology consult, and drug reaction.