Variability in treatment of UTIs in children with genitourinary anomalies in children's hospitals

Authors: FORSTER, CATHERINE - University Of Pittsburgh; WOOD, ALEXIS - Children'S Nutrition Research Center (CNRC); DAVIS-RODRIGUEZ, STEPHANIE - University Of Cincinnati College Of Medicine; DESAI, SANYUKTA - University Of Texas At Austin; CHANG, PEARL - University Of Washington School Of Medicine; TCHOU, MICHAEL - University Of Colorado; MORRISON, JOHN - Johns Hopkins University; HAMDY, RANA - Children'S National Medical Center; VEMULAKONDA, VIJAYA - University Of Colorado; BRADY, PATRICK - University Of Cincinnati College Of Medicine; ABOU ZEID, CYNTHIA - Baylor College Of Medicine; WALLACE, SOWDHAMINI - Baylor College Of Medicine

Submitted to: Hospital Pediatrics
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 11/15/2024
Publication Date: 3/25/2025
Citation: Forster, C.S., Wood, A.C., Davis-Rodriguez, S., Desai, S., Chang, P.W., Tchou, M.J., Morrison, J.M., Hamdy, R.F., Vemulakonda, V., Brady, P.W., Abou Zeid, C., Wallace, S.S. 2025. Variability in treatment of UTIs in children with genitourinary anomalies in children's hospitals. Hospital Pediatrics. 15(4):309-317. https://doi.org/10.1542/hpeds.2024-007914.
DOI: https://doi.org/10.1542/hpeds.2024-007914

Interpretive Summary: Obesity increases both the risk for urinary tract infections (UTI), and the likelihood that UTI are accompanied by fever ("febrile UTI") and require hospitalization. This study examined how children are treated for febrile UTIs across six children's hospitals in the U.S. Using data from 2017 to 2018, no significant differences between hospitals in IV antibiotic use, duration, and hospital stays was found, but also, no major differences in serious complications like bloodstream infections or ICU admissions. Similarly, despite these variations in treatment, the rate of return visits to the emergency department within 30 days remained consistent. This suggests that different treatment approaches do not necessarily lead to worse outcomes. The findings highlight the potential to standardize care and reduce unnecessary treatments while maintaining quality.

Technical Abstract: In children with urinary tract anomalies, febrile urinary tract infections (UTIs) are associated with increased risks of sepsis, hospitalization, and kidney injury. However, the best treatment strategies are unknown. We aimed to describe antibiotic treatment practices and outcomes for UTIs in children with urinary tract anomalies and evaluate whether variability in UTI treatment exists between hospitals. We conducted a multicenter retrospective cohort study of children seen in emergency departments (EDs) in 6 free-standing US children's hospitals from January 1, 2017, through December 31, 2018. We included children aged 0-17 years with an anatomic or functional urinary tract anomaly and a physician diagnosis of febrile or hypothermic UTI. Outcomes included intravenous (IV) antibiotic administration practices, hospitalization rates, length of stay, and return ED visits. Multivariable logistic and linear regression were performed, adjusting for differences in patient and illness characteristics. Among the 510 children included, anomaly types, presence of home catheterization regimens, and baseline glomerular filtration rates varied between sites. In the adjusted analyses, sites differed in several treatment practices: IV antibiotic administration before ED discharge (P=.007), IV antibiotic spectrum (P=.003), IV antibiotic duration (P<.001), and hospital length of stay (P<.001). No statistically significant differences existed with bacteremia (P=.24) or intensive care stays (P=.08). Returns to the ED within 30 days did not significantly differ by site (P=.68). Children's hospitals vary in their treatment of UTIs in children with urinary tract anomalies, yet ED revisits are similar across sites, highlighting the opportunity to promote high-value care in treatment of UTIs in this population.