Antibiotic Prescription Practice for Pediatric Urinary Tract Infection in a Tertiary Center
Notice bibliographique
Résumé
Abstract Background Urinary tract infection (UTI) is a leading cause for acute care visits in pediatrics. A suspected UTI diagnosis is made based on typical clinical presentation and pyuria and confirmed by significant growth in an appropriate urine sample. Prescribing antibiotics for suspected UTI is a common practice, and may lead to unnecessary antibiotic exposure. We aimed to review the practice of UTI diagnosis and management in the Emergency Department (ED) to identify targets to improve antimicrobial prescribing practices. Methods Children (< 18 years) who were discharged from the ED at the Hospital for Sick Children with a diagnosis of UTI between October to December 2016 were included. Patients were excluded if they were (1) under 12 weeks of age, (2) had underlying genitourinary abnormalities, (3) were admitted or transferred to another center, (4) were on antibiotics on presentation, (5) had urine testing done in another laboratory, or (6) were given conditional prescription. Demographic, clinical history, laboratory findings, and urine culture results were collected from patient charts. The sensitivity and specificity of nitrite and leukocyte esterase (LE) for UTI diagnosis were calculated. Logistic regression was used to examine the relationship between urinalysis characteristics and confirmed UTI. Results A total of 186 children with a median age of 4.2 (IQR 1.2, 7.3) were included; 82.3% were female. Almost all children were discharged home on antibiotics (n = 183, 98%) for a median duration of 7 days (IQR 7, 10). A total of 87 patients (46.8%) received antibiotics despite negative urine cultures and none of these patients received notification to stop. This led to 652 unnecessary antibiotic days. The presence of nitrites was the strongest predictor of UTI (OR 13.3, P < 0.001) and was highly specific. An LE result of 2+ (OR 2.4, P = 0.04) or 3+ (OR 2.23, P = 0.016) was also predictive of UTI. Conclusion Current practice in managing suspected pediatric UTIs in our ED resulted in significant and unnecessary antibiotic exposure. We identified targets to reduce unnecessary antibiotic exposure including improving the diagnostic accuracy of UTIs, a process to discontinue antibiotics for negative cultures and standardizing antimicrobial duration. Disclosures All authors: No reported disclosures.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,003 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».