Antibiotic Overtreatment of Presumed Urinary Tract Infection among Children with Spina Bifida

Abstract

Objective: To identify factors associated with overtreatment of presumed urinary tract infection (UTI) among children with spina bifida using such criteria.

Study design: A retrospective review of children with spina bifida (age < 21 years) evaluated in the Emergency Department (ED) at a single institution was performed. Patients with a urinalysis (UA) performed who were reliant on assisted bladder emptying were included. The primary outcome was overtreatment, defined as receiving antibiotics for presumed UTI but ultimately not meeting spina bifida UTI criteria (≥ 2 urologic symptoms plus pyuria and urine culture growing >100k CFU/mL). The primary exposure was whether the components of the criteria available at the time of the ED visit (≥ 2 urologic symptoms plus pyuria) were met when antibiotics were initiated.

Results: Among 236 ED encounters, overtreatment occurred in 80% of cases in which antibiotics were initiated (47% of the entire cohort). Pyuria with <2 urologic symptoms was the most important factor associated with overtreatment (OR 9.6). Non-Hispanic White race was associated with decreased odds of overtreatment (OR 0.3).

Conclusions: Overtreatment of presumed UTI among patients with spina bifida was common. Pyuria, which is not specific to UTI in this population, was the main driver of overtreatment. Symptoms are a cornerstone of UTI diagnosis among children with spina bifida, should be collected in a standardized manner, and considered in a decision to treat.

Keywords: antibiotics; antimicrobial stewardship; emergency department; spina bifida; urinary tract infection.