Antimicrobial stewardship programs (ASPs) target antimicrobial use in the inpatient care sites. Most of antimicrobial prescribing happens at ambulatory sites. We conducted a retrospective study to determine the appropriateness of diagnosis and treatment of uncomplicated UTI in children in the outpatient at our institution. We estimated the cost of antibiotic treatment in the included patients.
We reviewed electronic records of patients aged 2-18 years diagnosed with uncomplicated UTI and treated with antibiotics in the outpatient from January 1, 2016 to April 30, 2016. Appropriate diagnosis was defined as confirmed UTI which included: pyuria (>5 WBC per HPF or positive for LE), a positive urine culture (≥50,000 colony units/mL of a single uropathogen for a catheterized sample or ≥ 100,000 colony units/mL for a clean catch urine sample), and lower urinary tract symptoms. Treatment was considered appropriate if the patient was prescribed first-line antibiotic for the susceptible isolate (trimethoprim sulfamethoxazole/TMP-SMX, amoxicillin-clavulanate, nitrofurantoin, & cephalexin), appropriate dose was calculated, and duration of treatment was 3-10 days. 3rd generation cephalosporins and quinolones were considered broad spectrum antibiotics. Cost of antibiotic treatment was estimated for both groups.
We included 178 patients diagnosed with uncomplicated UTI and treated with antibiotics. Of all patients, 70% were inappropriately diagnosed (n=125) with polymicrobial growth in their urine cultures (58%, n=72). Antibiotics prescribed mostly in this group were TMP-SMX (53%, n=66) and cephalexin (22%, n=27). Only 30% of all included patients were appropriately diagnosed (n=53). Of all appropriately diagnosed patients (n=53), 26% were treated inappropriately (n=14) with wide spectrum antibiotics (n=8) or with low calculated dose (n=6). Wide spectrum antibiotics were prescribed in 15% (n=26) of all patients. The estimated cost of antibiotic treatment for inappropriately diagnosed group (n=125) was 10,755.87$.
ASPs should target the pediatric outpatient and antibiograms should be developed. Education of providers about the appropriate diagnosis and treatment of uncomplicated UTI in children is essential in reducing the cost of therapy.
M. M. Al-Tabbaa, None
B. Barnacle, None
J. Ren, None
M. Aiyer, None
R. Tapping, None