318 - Variability in Treatment of Febrile Urinary Tract Infections in Children with Genitourinary Anomalies

Poster Number: 318
Publication Number: 318.213

Catherine Forster, UPMC Childrens Hospital of Pittsburgh, Pittsburgh, PA, United States; Alexis C. Wood, Baylor College of Medicine, Houston, TX, United States; Stephanie Davis-Rodriguez, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Sanyukta Desai, University of Washington School of Medicine, Seattle, WA, United States; Pearl Chang, Seattle Children's Hospital / University of Washington, Seattle, WA, United States; Michael J. Tchou, University of Colorado Anschutz and Children's Hospital of Colorado, DENVER, CO, United States; John M. Morrison, Johns Hopkins All Children's Hospital, Saint Petersburg, FL, United States; Rana F. Hamdy, Children's National Health System, Washingtotn, DC, United States; Cynthia Abou Zeid, Baylor College of Medicine, Houston, TX, United States; Jamie N. Doctrow, Cincinnati Children's Hospital Medical Center, Fort Thomas, KY, United States; Brittany D. Casey, Johns Hopkins All Children's Hospital, Saint Petersburg, FL, United States; Victor R. Trevisanut, Pediatric Urology Research Enterprise (PURE), Department of Pediatric Urology, Children's Hospital Colorado, Aurora, CO; Division of Urology, Department of Surgery, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, Denver, CO, United States; Vijaya M. Vemulakonda, Children's Hospital Colorado, Aurora, CO, United States; Patrick Brady, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Sowdhamini S. Wallace, Baylor College of Medicine, Houston, TX, United States

Background: Febrile urinary tract infections (UTIs) are common in children with genitourinary (GU) anomalies and associated with increased risks of sepsis, hospitalization, and kidney injury. These risks highlight the need for evidence-based recommendations to guide treatment, however, few studies exist to inform best practices.

Objective: To describe antibiotic treatment practices and outcomes for febrile UTIs in children with GU anomalies and evaluate whether variability in treatment exists between hospitals.

Design/Methods: We conducted a multicenter retrospective cohort study of children seen in emergency departments (EDs) in six free-standing US children’s hospitals from 1/1/2017-12/31/2018. We included children 0-17 years old with a physician diagnosis of febrile UTI and either neurogenic bladder, obstructive uropathies, renal dysplasias, duplication, or high-grade vesicoureteral reflux (VUR). We excluded children with bacterial meningitis, renal abscess, or end-stage renal disease. Outcomes included intravenous (IV) antibiotics prescribed prior to ED discharge, hospitalization, duration of IV antibiotic treatment, and return ED visits. Multilevel logistic regression was performed to evaluate for variability in treatment and outcomes between hospitals, adjusting for differences in patient and illness characteristics.

Results: Of the 505 children included, the mean age was 5.7 years (SD 5.3). Most had bladder lesions (44%), upper tract dilation (17%), or mixed GU anomaly types with VUR (20%); 43% had home catheterization regimens and 3% had indwelling GU hardware. Several patient and illness characteristics varied between sites (Table 1). Fifty-two percent (n=263) of children were hospitalized and 9% (n=43) received intensive care. In the bivariate analysis, variation in treatment was identified between sites in the proportion of children hospitalized (p < 0.001), the proportion that received IV antibiotics prior to ED discharge (p < 0.001, Figure 1) and the duration of IV antibiotics (p < 0.001, Figure 2). Returns to the ED within 30 days did not significantly differ by site (p=0.94). In the adjusted analyses, site differences in ED administration of IV antibiotics prior to discharge (OR 63.88) and hospitalization rates (OR 3.64) remained.Conclusion(s): Variation in admitting practice and treatment exists for children with GU anomalies in children’s hospitals yet ED revisits are similar across sites.  Further large, prospective studies are needed to delineate best practices for febrile UTI treatment and to promote high-value care in this population.
Comparison of Patient and Illness Characteristics Between Six Children’s Hospitals
Variation in Treatment Practices of Febrile Urinary Tract Infections in Children with Genitourinary Anomalies at Six Children’s Hospitals