Perinatal & Pediatric
Concordance with pediatric urinary tract infection clinical guidelines and short-term outcomes in children in the US Military Health System Yixin Chen* Yixin Chen Chen Chen Chen Chen Chen Chen Chen Chen Deployment Health Research Department, Naval Health Research Center, San Diego, California; Leidos, Inc., San Diego, California
Background: Urinary tract infection (UTI) is a common bacterial infection in early childhood. Inappropriate treatment may lead to adverse short-term outcomes. We assessed concordance with American Academy of Pediatrics guidelines in testing, treatment, and management of UTI, and evaluated the risk of selected adverse outcomes associated with treatment non-concordance in US military-connected children.
Methods: We used Birth and Infant Health Research program data to identify children born January 2012-October 2021 and aged 2-24 months at first UTI diagnosis. Utilizing administrative medical data, we defined testing concordance as having both a urine culture and urinalysis within ± 3 days of diagnosis, treatment concordance as being prescribed proper antibiotics with recommended duration (i.e., 7-14 days) within 5 days of diagnosis, and management concordance as having a renal and bladder ultrasound (RBUS) within 90 days of diagnosis or before a 2nd UTI. Selected adverse health outcomes included antibiotic allergy within 14 days, Clostridium difficile, diarrhea, ER visit, or hospitalization within 30 days of antibiotic dispensation. Adjusted modified Poisson models estimated the risk of any adverse outcome with treatment non-concordance.
Results: A total of 14,112 children with first UTI treated with antibiotics were included. For testing, 8038 (57.0%) infants had both a urine culture and urinalysis done. For treatment, 12,180 (86.3%) infants had proper antibiotics with recommended duration. For management, 3697 (26.2%) had RBUS. We observed 2056 (14.6%) infants with any of the selected adverse outcomes and estimated a null association with treatment non-concordance (RR=1.00, 95% CI: 0.89-1.12).
Conclusion: Many infants with an initial UTI are not receiving recommended diagnostic tests or follow-up imaging, highlighting the need for improved practice guidance. High treatment concordance may limit the power to detect differences in short-term adverse outcomes.