345 - Improving the selection and duration of the antibiotic for urinary tract infection in children

Poster Number: 345
Publication Number: 345.345

Foram Patel, Southern Illinois University School of Medicine, Springfield, IL, United States; Mary Katherine Siebenaler, Southern Illinois University School of Medicine, Springfield, IL, United States; Aysha Rafaquat, HSHS St.JOhn's Hospital, Springfield, IL, United States; Ezzeldin Saleh, Southern Illinois University School of Medicine, Springfield, IL, United States; Peter S. Kieffer, Southern Illinois University School of Medicine, Springfield, IL, United States

Background: Urinary tract infection(UTI) is the second most common bacterial infection in children after acute otitis media. As per CDC data, the prescribing antibiotic was not supported in 77% of patients with UTI. Previous studies showed E.coli isolated from urine cultures had low resistance to cefazolin which therefore is the preferred option in areas with high( >80%)susceptibility. Ideal duration of antibiotic for UTI in children is unknown. The growing evidence supports the use of antibiotic for shorter duration(7 days or less)for UTI in children, particularly in >24months of age.

Objective: Our local goal, as a participant in the AAP VIP BASiC(Value in Pediatrics Better Antibiotic Selection in Children)project, was to increase use of Cefazolin(IV) or Cephalexin(PO)as empiric therapy and to prescribe antibiotic for shorter effective duration(7 days) in 85% children with UTI over 12 months.

Design/Methods: Local baseline data was collected from July 2019-February 2021 followed by implementation cycles from March 2021-November 2021. Previously healthy children aged 2 months-18 years, without abnormal genitourinary anatomy or history of resistant organisms in urine culture, were included. Our PDSA cycle interventions were: reviewing and sharing local urine culture sensitivities that show 100%susceptibility of urine E.coli to cefazolin, sharing an evidence-based summary of references to support recommendations with pediatric and ER providers, providing in-time peer-peer feedback to pediatric and ER residents and faculty during admission calls, creating and sharing pediatric UTI pathways and guidelines, educational talks covering supportive evidence, distributing visual guides and flowcharts with information on 1st choice of antibiotic and duration.

Results: A total subject of 226(166 >24 months of age) with UTI were reviewed. Proportion of appropriate empiric antibiotic improved from baseline of 75%(monthly cycle 1-20) to 100% in cycle 29 with most recent 9 points over baseline, suggesting improvement(figure 1). Proportion of subjects prescribed antibiotic for appropriate duration appears improved from baseline(figure 2). The length of stay, revisits/readmissions, and need for ICU level care remained stable.Conclusion(s): Following multiple PDSA cycles, our local practice increased using a 1st generation cephalosporin as empiric treatment for UTI in children and prescribing antibiotic for 7 days in children >24months with UTI, without increase in adverse outcomes. Our next step will be to implement an EMR decision support tool for ED providers offering first line choice of drug, dose, duration for UTI in children.
Run chart of Appropriate Empiric Antibiotic for UTI in Children 2 months – 17 years
Run chart of Appropriate Duration of Antibiotic for UTI in Children > 24 months