1498. Testing for and Diagnosis of Urinary Tract Infections in Febrile Children in the Emergency Department
Session: Poster Abstract Session: Antimicrobial Stewardship: Role of Diagnostics
Saturday, October 10, 2015
Room: Poster Hall
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  • Background: Fever protocols used in the Pediatric Emergency Department dictate urine collection on many young children, regardless of risk categorization for urinary tract infections (UTI) or presence of viral symptoms. Guidelines published by the American Academy of Pediatrics (AAP) in 2011 provided clarification on patients who require testing/treatment for UTIs. The objective of this initiative was to determine if febrile children 2-24 months seen in the Pediatric Emergency Department from 2012-2013 were appropriately tested for, and diagnosed with UTI as based on 2011 AAP Guidelines. 

    Methods: A retrospective Medical Records Review was conducted for patients ages 2-24 months seen in the Pediatric Emergency Department and diagnosed with UTI/Pyelonephritis.  Multiple elements were reviewed, primarily focusing on urine microscopy and urine culture results, concurrent illnesses and treatment.

    Results: We identified 338 patients who were diagnosed with a UTI and treated with an antibiotic. Of these, 196 patients (58%) had a negative culture, 120 were female and 76 were male, 61% had concurrent viral symptoms and 11 (6%) had otitis media diagnosed.  Enteral third generation cephalosporin was prescribed to 217 patients, 151 of whom did not meet UTI criteria (79%). Forty-four patients who did not meet UTI criteria had a renal ultrasound performed.  Of those who had antibiotics prescribed based on urinalysis results with negative cultures, no mechanism exists to identify those patients and stop antibiotic use. 

    Conclusion: We present a retrospective review that reveals many children are diagnosed with and treated with broad spectrum antimicrobials for a UTI despite not meeting AAP criteria.  Thus, we will look at prescribing practices and any change in clinical practice (e.g., watchful waiting, obtaining radiographs) that may enhance patient safety and improve patient satisfaction in the Pediatric Emergency Room by incorporating results of this study and AAP guidelines into the various protocols (fever, UTI management, imaging, antimicrobial use, etc.) in use within the Pediatric Emergency Department.

    Sarah Deyo, PA-C1, Emily Richard, MD1 and Michael Bolton, MD2, (1)Emergency Medicine, Our Lady of the Lake Children's Hospital, Baton Rouge, LA, (2)Section of Infectious Diseases, Our Lady of the Lake Children's Hospital, Baton Rouge, LA


    S. Deyo, None

    E. Richard, None

    M. Bolton, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.