874. To be or not to be a UTI: An Opportunity for Antimicrobial Stewardship in a Pediatric Hospital
Session: Poster Abstract Session: Pediatric Antimicrobial Stewardship
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • UTI ASP poster_IDweek October 2013 Oct 1.pdf (1.0 MB)
  • Background: Treating true infections rather than contamination or colonization is one of the principles of antimicrobial stewardship (AS).  This is especially true for urinary tract infections (UTI) in children less than 2 years.  The objective of this study was to compare the antimicrobial treatment and clinical investigations in patients who fulfilled UTI diagnostic criteria with those that did not in order to assess whether an AS intervention is warranted.

    Methods: A retrospective chart review was undertaken for infants 1-24 months discharged from the Children’s Hospital of Eastern Ontario with a primary discharge diagnosis of UTI (ICD-10 code N39.0) between Sept. 1, 2007 and Sept. 1, 2011. Patients with pre-existing renal abnormalities, therapy prior to admission, prior UTIs or with missing data were excluded.  Fever was defined as a temperature of > 38.5°C (101.3°F) .  UTI diagnostic criteria was the presence of (1) fever, (2) one uropathogen ≥ 5 X 107/L (equivalent to ≥50,000 per ml) and (3) either >5 WBC per HPF on microscopy or a positive leukocyte esterase or positive urinary nitrates.

    Results: Of the 263 patients identified, 62 were excluded.  Of the remaining 201, 112 (55.7%) were male and 93 (46.3%) were between 2 and 24 months of age.  Fever and one uropathogen was present in 109 (54.2%) and 134 (66.7%) of patients, respectively.  108 (62.4%) had >5 WBC, 49 (26.1%) had positive urinary nitrates and 127 (67.9%) had positive leukocyte esterase.  The diagnostic criteria could not be applied in 6 cases due to missing data. Of the remaining 195 patients, only 69 (35.4%) met criteria.  Comparing those who met criteria and those who did not, the mean (SD) days of hospitalization was 4.8 (3.1) versus 5.0 (2.0) and the mean days of antimicrobials 9.1 (2.8) versus 8.4 (3.0).  The majority of patients underwent ultrasound, blood culture, and voiding cystourethrogram (VCUG) regardless of whether they met diagnostic criteria.

    Conclusion: In this cohort with a discharge diagnosis of UTI, nearly two thirds did not meet diagnostic criteria, yet received similar treatment to those who did.  By consistently applying diagnostic criteria, we could have potentially avoided 1611 days of antimicrobials and 655 days of hospitalization.  This represents an important opportunity for AS in a pediatric hospital setting.

    Nicole Le Saux, MD1,2, Annie Pouliot, Pharm D3, Régis Vaillancourt, Pharm D4, Nicholas Barrowman, PHD5, Mary Aglipay, MSc(c)5, Janusz Feber, MD6, Anne K. Rowan-Legg, MD7 and Jennifer Bowes, MSc8, (1)Infection Prevention and Control, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada, (2)Pediatrics, University of Ottawa, Ottawa, ON, Canada, (3)Pharmacy and Pain Services, Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada, (4)Pharmacy, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada, (5)Children's Hospital of Eastern Ontario Clinical Research Unit, Ottawa, ON, Canada, (6)Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada, (7)Division of Pediatric Medicine, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada, (8)Pediatrics, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada

    Disclosures:

    N. Le Saux, None

    A. Pouliot, None

    R. Vaillancourt, None

    N. Barrowman, None

    M. Aglipay, None

    J. Feber, None

    A. K. Rowan-Legg, None

    J. Bowes, None

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.