MP53-06: Spina bifida-specific criteria for UTI diagnosis reflect only a subset of empiric antibiotic use among children with spina bifida seen in the emergency department
Introduction: Spina bifida (SB)-specific criteria for urinary tract infection (UTI) diagnosis are stricter than those for the general pediatric population in effort to avoid overtreatment. It is unknown how closely these criteria are followed in the emergency department (ED) setting. The objective of this study was to examine the clinical factors associated with initiation of empiric antibiotics for UTI in children with SB seen in the ED. Methods: A single-institution retrospective database of children with SB (age < 21 years) presenting to the ED between 2016 and 2020 was queried. Only encounters with urinalysis (UA) performed were included. The primary outcome was initiation of empiric antibiotics for UTI. Covariables included baseline patient and clinical characteristics. Specific urologic presenting symptoms (fever = 38C, abdominal/flank/urethral pain, malodorous/cloudy urine, urinary incontinence) and components of the UA (pyuria [>10 WBC/hpf], nitrites, turbidity, identification of bacteria) were collected. Proportion of patients meeting previously published SB-specific criteria for UTI in the pre-culture setting (=2 urologic symptoms plus pyuria) were examined. Analysis included descriptive statistics and examining the association between presenting factors with use of empiric antibiotics using multivariable logistic regression. Results: Out of 1,487 encounters, 299 were included comprising 92 unique patients (median 2 encounters per patient, range 1 - 22). Median encounter age was 8 years (range 0.04 – 20). Patients were majority female (60%), Hispanic (55%), and had a myelomeningocele (72%) with supra-sacral lesion (77%). Empiric antibiotics for UTI were initiated in 56%. Only 36% of those receiving antibiotics met SB-specific criteria. Among those receiving antibiotics pyuria was the most common UA finding (88%). When adjusting for covariables, antibiotic use was associated with fever (OR 2.9), cloudy urine (OR 6.5) and the following individual UA components: pyuria (OR 11), nitrites (OR 4.4), urine turbidity (OR 3.5), and bacteria (OR 2.1) (all p < 0.05). Conclusions: Antibiotics were given to about half of children with SB presenting to the ED when a UA was obtained. Receipt of antibiotics was associated with fever and cloudy urine. Among the UA components, pyuria had the strongest association. Only about one third of those receiving antibiotics met the combination of SB-specific criteria for a UTI diagnosis, raising concern for overuse of empiric antibiotics in this population. SOURCE OF Funding: None.
