1330 - Development of a Pediatric Emergency Department (ED) Uropathogen Antibiogram and Empiric Urinary Tract Infection (UTI) Treatment Algorithm

Background: Antimicrobial Stewardship efforts in adult ED settings lead to improved patient outcomes and fewer adverse events. However, there are limited data on incorporation of multiple interventions to assist with empiric and definitive antibiotic therapy selection, particularly in the pediatric ED setting. The purpose of this project was to create an antibiogram and empiric UTI treatment algorithm for use in a pediatric ED.

Methods: This is a multi-phase program implementation in a pediatric ED. Patients aged 2 months -18 years presenting to the ED between January to December 2018 with an ICD10 code for cystitis or pyelonephritis and collection of urine culture were included. Patients were excluded if they were admitted to an inpatient unit or they had a polymicrobial urine culture result. The antibiogram was prepared by including the first isolate of a species from each patient in the given time frame using Clinical and Laboratory Standards Institute recommendations.

Results: A total of 145 unique patients with 160 ED encounters were included in phase I of the project. Median patient age was 5 years (IQR 1.4-8). Discharge diagnosis for 75% of the 160 ED encounters was pyelonephritis. Urogenital flora was cultured from 19.4% of cultures and 21.2% of cultures were without any growth. The most common pathogen isolated was E. coli (39.4%). For ages 2 months – 18 years, susceptibility of urinary E. coli isolates was 95.5% for nitrofurantoin, 92.5% each for ceftriaxone and ciprofloxacin, and 85.1% for cefazolin. Cefdinir and cephalexin were the empiric antibiotics prescribed on discharge 76.3% of the time. After consideration of factors such as antimicrobial stewardship and spectrum of activity, cephalexin was chosen as the treatment of choice for the 2 months – 11 years age group. For children ≥ 12 years, nitrofurantoin was selected as preferred treatment for uncomplicated cystitis while cephalexin was selected as preferred treatment for pyelonephritis.M Health Fairview University of Minnesota Masonic Childrens ED 2018 E coli isolate antibiogram


Conclusion: An empiric UTI treatment algorithm incorporating local antimicrobial susceptibility pattern alongside recommendations from national organizations was created. Phase II of the project will evaluate the implementation of the algorithm to determine its impact on readmission rates and antibiotic/pathogen mismatch.