PMID- 28302674
DCOM- 20170803
LR  - 20170803
IS  - 1098-4275 (Electronic)
IS  - 0031-4005 (Linking)
VI  - 139
IP  - 4
DP  - 2017 Apr
TI  - Urine Culture Follow-up and Antimicrobial Stewardship in a Pediatric Urgent Care 
LID - e20162103 [pii]
LID - 10.1542/peds.2016-2103 [doi]
AB  - BACKGROUND AND OBJECTIVES: Empiric antibiotic therapy for presumed urinary tract 
      infection (UTI) leads to unnecessary antibiotic exposure in many children whose
      urine culture results fail to confirm the diagnosis. The objective of this
      quality improvement study was to improve follow-up management of negative urine
      culture results in the off-campus urgent care network of Nationwide Children's
      Hospital to reduce inappropriate antibiotic exposure in children. METHODS: A
      multidisciplinary task force developed and implemented a protocol for routine
      nurse and clinician follow-up of urine culture results, discontinuation of
      unnecessary antibiotics, and documentation in the electronic medical record.
      Monthly antibiotic discontinuation rates were tracked in empirically treated
      patients with negative urine culture results from July 2013 through December
      2015. Statistical process control methods were used to track improvement over
      time. Fourteen-day return visits for UTIs were monitored as a balancing measure. 
      RESULTS: During the study period, 910 patients received empiric antibiotic
      therapy for UTIs but had a negative urine culture result. The antibiotic
      discontinuation rate increased from 4% to 84%, avoiding 3429 (40%) of 8648
      antibiotic days prescribed. Among patients with discontinued antibiotics, none
      was diagnosed with a UTI within 14 days of the initial urgent care encounter.
      CONCLUSIONS: Implementation of a standard protocol for urine culture follow-up
      and discontinuation of unnecessary antibiotics was both effective and safe in a
      high-volume pediatric urgent care network. Urine culture follow-up management is 
      an essential opportunity for improved antimicrobial stewardship in the outpatient
      setting that will affect many patients by avoiding a substantial number of
      antibiotic days.
CI  - Copyright (c) 2017 by the American Academy of Pediatrics.
FAU - Saha, Dipanwita
AU  - Saha D
AD  - Department of Pediatrics.
FAU - Patel, Jimisha
AU  - Patel J
AD  - Department of Pediatrics.
FAU - Buckingham, Don
AU  - Buckingham D
AD  - Quality Improvement Services, and.
FAU - Thornton, David
AU  - Thornton D
AD  - Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, 
      The Ohio State University, Columbus, Ohio.
FAU - Barber, Terry
AU  - Barber T
AD  - Department of Pediatrics.
FAU - Watson, Joshua R
AU  - Watson JR
AD  - Department of Pediatrics,
LA  - eng
PT  - Journal Article
DEP - 20170316
PL  - United States
TA  - Pediatrics
JT  - Pediatrics
JID - 0376422
RN  - 0 (Anti-Infective Agents)
SB  - IM
MH  - Ambulatory Care/statistics & numerical data
MH  - Anti-Infective Agents/*therapeutic use
MH  - Child
MH  - Follow-Up Studies
MH  - Hospitals, Pediatric/statistics & numerical data
MH  - Humans
MH  - Quality Improvement
MH  - Urinalysis/methods
MH  - Urinary Tract Infections/*diagnosis/drug therapy
MH  - Urine/*microbiology
COIS- POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential
      conflicts of interest to disclose.
EDAT- 2017/03/18 06:00
MHDA- 2017/08/05 06:00
CRDT- 2017/03/18 06:00
PHST- 2016/12/19 00:00 [accepted]
PHST- 2017/03/18 06:00 [pubmed]
PHST- 2017/08/05 06:00 [medline]
PHST- 2017/03/18 06:00 [entrez]
AID - peds.2016-2103 [pii]
AID - 10.1542/peds.2016-2103 [doi]
PST - ppublish
SO  - Pediatrics. 2017 Apr;139(4). pii: peds.2016-2103. doi: 10.1542/peds.2016-2103.
      Epub 2017 Mar 16.