Urinary Tract Infection and Antimicrobial Stewardship in the Emergency Department

Joshua R. Watson, Pablo J. Sánchez, John David Spencer, Daniel M. Cohen, David Hains

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Objectives The aims of this study were to assess empiric antibiotic use for presumed urinary tract infection (UTI) in the emergency department (ED) and to determine how often urine culture results subsequently do not confirm the diagnosis. Methods This study is a retrospective cohort study of patients aged 21 years or younger in the Nationwide Children's Hospital ED from May 1, 2012, to October 31, 2012, who had a urinalysis and urine culture performed and were discharged home with empiric antibiotic therapy for presumed UTI. Patients with known urinary tract anomaly or antibiotic use in the previous 7 days were excluded. Confirmed UTI was defined as pyuria (>5 white blood cells per high-power field or dipstick positive for leukocyte esterase) and a positive urine culture (≥50,000 colony-forming units/mL of a uropathogen). Results Of the 175 enrolled patients, urine was obtained by clean catch in 138 (79%), catheterization in 35 (20%), first-pass void in 1 (0.6%), and undocumented method in 1 (0.6%). Pyuria was demonstrated in 164 patients (94%), but only 97 (55%) had a positive urine culture. The combination of pyuria and a positive urine culture confirmed UTI in 90 patients (51%). The most commonly prescribed antibiotics were cefdinir in 103 patients (59%), trimethoprim/sulfamethoxazole in 40 (23%), and ciprofloxacin in 23 (13%). The median duration of prescribed therapy was 10 days (interquartile range, 7-10 days). Treatment duration was correlated negatively with age (r = -0.53, P < 0.01). Conclusions The current management of suspected UTI in ED patients results in unnecessary antibiotic exposure, highlighting an important opportunity for outpatient antimicrobial stewardship efforts.

Original languageEnglish (US)
Pages (from-to)93-95
Number of pages3
JournalPediatric Emergency Care
Volume34
Issue number2
DOIs
StatePublished - Feb 1 2018

Fingerprint

Urinary Tract Infections
Hospital Emergency Service
Urine
Pyuria
Anti-Bacterial Agents
cefdinir
Urinalysis
Hospital Departments
Sulfamethoxazole Drug Combination Trimethoprim
Ciprofloxacin
Urinary Tract
Catheterization
Leukocytes
Cohort Studies
Outpatients
Stem Cells
Therapeutics
Retrospective Studies

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health
  • Emergency Medicine

Cite this

Urinary Tract Infection and Antimicrobial Stewardship in the Emergency Department. / Watson, Joshua R.; Sánchez, Pablo J.; Spencer, John David; Cohen, Daniel M.; Hains, David.

In: Pediatric Emergency Care, Vol. 34, No. 2, 01.02.2018, p. 93-95.

Research output: Contribution to journalArticle

Watson, Joshua R. ; Sánchez, Pablo J. ; Spencer, John David ; Cohen, Daniel M. ; Hains, David. / Urinary Tract Infection and Antimicrobial Stewardship in the Emergency Department. In: Pediatric Emergency Care. 2018 ; Vol. 34, No. 2. pp. 93-95.
@article{729676d6e5b1445aa303d1f63c5057e1,
title = "Urinary Tract Infection and Antimicrobial Stewardship in the Emergency Department",
abstract = "Objectives The aims of this study were to assess empiric antibiotic use for presumed urinary tract infection (UTI) in the emergency department (ED) and to determine how often urine culture results subsequently do not confirm the diagnosis. Methods This study is a retrospective cohort study of patients aged 21 years or younger in the Nationwide Children's Hospital ED from May 1, 2012, to October 31, 2012, who had a urinalysis and urine culture performed and were discharged home with empiric antibiotic therapy for presumed UTI. Patients with known urinary tract anomaly or antibiotic use in the previous 7 days were excluded. Confirmed UTI was defined as pyuria (>5 white blood cells per high-power field or dipstick positive for leukocyte esterase) and a positive urine culture (≥50,000 colony-forming units/mL of a uropathogen). Results Of the 175 enrolled patients, urine was obtained by clean catch in 138 (79{\%}), catheterization in 35 (20{\%}), first-pass void in 1 (0.6{\%}), and undocumented method in 1 (0.6{\%}). Pyuria was demonstrated in 164 patients (94{\%}), but only 97 (55{\%}) had a positive urine culture. The combination of pyuria and a positive urine culture confirmed UTI in 90 patients (51{\%}). The most commonly prescribed antibiotics were cefdinir in 103 patients (59{\%}), trimethoprim/sulfamethoxazole in 40 (23{\%}), and ciprofloxacin in 23 (13{\%}). The median duration of prescribed therapy was 10 days (interquartile range, 7-10 days). Treatment duration was correlated negatively with age (r = -0.53, P < 0.01). Conclusions The current management of suspected UTI in ED patients results in unnecessary antibiotic exposure, highlighting an important opportunity for outpatient antimicrobial stewardship efforts.",
author = "Watson, {Joshua R.} and S{\'a}nchez, {Pablo J.} and Spencer, {John David} and Cohen, {Daniel M.} and David Hains",
year = "2018",
month = "2",
day = "1",
doi = "10.1097/PEC.0000000000000688",
language = "English (US)",
volume = "34",
pages = "93--95",
journal = "Pediatric Emergency Care",
issn = "0749-5161",
publisher = "Lippincott Williams and Wilkins",
number = "2",

}

TY - JOUR

T1 - Urinary Tract Infection and Antimicrobial Stewardship in the Emergency Department

AU - Watson, Joshua R.

AU - Sánchez, Pablo J.

AU - Spencer, John David

AU - Cohen, Daniel M.

AU - Hains, David

PY - 2018/2/1

Y1 - 2018/2/1

N2 - Objectives The aims of this study were to assess empiric antibiotic use for presumed urinary tract infection (UTI) in the emergency department (ED) and to determine how often urine culture results subsequently do not confirm the diagnosis. Methods This study is a retrospective cohort study of patients aged 21 years or younger in the Nationwide Children's Hospital ED from May 1, 2012, to October 31, 2012, who had a urinalysis and urine culture performed and were discharged home with empiric antibiotic therapy for presumed UTI. Patients with known urinary tract anomaly or antibiotic use in the previous 7 days were excluded. Confirmed UTI was defined as pyuria (>5 white blood cells per high-power field or dipstick positive for leukocyte esterase) and a positive urine culture (≥50,000 colony-forming units/mL of a uropathogen). Results Of the 175 enrolled patients, urine was obtained by clean catch in 138 (79%), catheterization in 35 (20%), first-pass void in 1 (0.6%), and undocumented method in 1 (0.6%). Pyuria was demonstrated in 164 patients (94%), but only 97 (55%) had a positive urine culture. The combination of pyuria and a positive urine culture confirmed UTI in 90 patients (51%). The most commonly prescribed antibiotics were cefdinir in 103 patients (59%), trimethoprim/sulfamethoxazole in 40 (23%), and ciprofloxacin in 23 (13%). The median duration of prescribed therapy was 10 days (interquartile range, 7-10 days). Treatment duration was correlated negatively with age (r = -0.53, P < 0.01). Conclusions The current management of suspected UTI in ED patients results in unnecessary antibiotic exposure, highlighting an important opportunity for outpatient antimicrobial stewardship efforts.

AB - Objectives The aims of this study were to assess empiric antibiotic use for presumed urinary tract infection (UTI) in the emergency department (ED) and to determine how often urine culture results subsequently do not confirm the diagnosis. Methods This study is a retrospective cohort study of patients aged 21 years or younger in the Nationwide Children's Hospital ED from May 1, 2012, to October 31, 2012, who had a urinalysis and urine culture performed and were discharged home with empiric antibiotic therapy for presumed UTI. Patients with known urinary tract anomaly or antibiotic use in the previous 7 days were excluded. Confirmed UTI was defined as pyuria (>5 white blood cells per high-power field or dipstick positive for leukocyte esterase) and a positive urine culture (≥50,000 colony-forming units/mL of a uropathogen). Results Of the 175 enrolled patients, urine was obtained by clean catch in 138 (79%), catheterization in 35 (20%), first-pass void in 1 (0.6%), and undocumented method in 1 (0.6%). Pyuria was demonstrated in 164 patients (94%), but only 97 (55%) had a positive urine culture. The combination of pyuria and a positive urine culture confirmed UTI in 90 patients (51%). The most commonly prescribed antibiotics were cefdinir in 103 patients (59%), trimethoprim/sulfamethoxazole in 40 (23%), and ciprofloxacin in 23 (13%). The median duration of prescribed therapy was 10 days (interquartile range, 7-10 days). Treatment duration was correlated negatively with age (r = -0.53, P < 0.01). Conclusions The current management of suspected UTI in ED patients results in unnecessary antibiotic exposure, highlighting an important opportunity for outpatient antimicrobial stewardship efforts.

UR - http://www.scopus.com/inward/record.url?scp=84957706427&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84957706427&partnerID=8YFLogxK

U2 - 10.1097/PEC.0000000000000688

DO - 10.1097/PEC.0000000000000688

M3 - Article

VL - 34

SP - 93

EP - 95

JO - Pediatric Emergency Care

JF - Pediatric Emergency Care

SN - 0749-5161

IS - 2

ER -