Compliance with guidelines for the medical care of first urinary tract infections in infants: a population-based study.
BACKGROUND
No population-based studies have examined the degree to which practice parameters are followed for urinary tract infections in infants.


OBJECTIVE
To describe the medical care of children in their first year of life after a first urinary tract infection.


METHODS
Using Washington State Medicaid data, we conducted a retrospective cohort study of children with a urinary tract infection during their first year of life to determine how many of these children received recommended care based on the most recent guidelines from the American Academy of Pediatrics. Recommended care included timely anatomic imaging, timely imaging for reflux, and adequate antimicrobial prophylaxis. Multivariate logistic-regression models were used to evaluate if hospitalization for first urinary tract infection, young age at time of diagnosis, gender, race, primary language of parents, having a managed care plan, and rural location of household residence were associated with recommended care.


RESULTS
Less than half of all children diagnosed with a urinary tract infection in their first year of life received the recommended medical care. Children who were hospitalized for their first urinary tract infection were significantly more likely than children who were not hospitalized to receive anatomic imaging (relative risk [RR]: 1.38; 95% confidence interval [CI]: 1.20-1.57) and imaging for reflux (RR: 1.62; 95% CI: 1.34-1.90).


CONCLUSIONS
There is poor compliance with guideline-recommended care for first urinary tract infections in infants in a Medicaid population. Given the trend toward increased outpatient management of urinary tract infections, increased attention to outpatient imaging may be warranted.
Cohen
Adam L
AL
Department of Pediatrics, University of Washington, 6200 NE 74th St, Suite 210, Seattle, WA 98115-8160, USA. alcohen@u.washington.edu
Rivara
Frederick P
FP
Davis
Robert
R
Christakis
Dimitri A
DA
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis / Q000706:statistics & numerical data; D015331:Cohort Studies; D003952:Diagnostic Imaging / Q000706:statistics & numerical data; D004198:Disease Susceptibility; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D038801:International Classification of Diseases; D008297:Male; D008329:Managed Care Programs; D008484:Medicaid / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011859:Radiography; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D014463:Ultrasonography; D014552:Urinary Tract Infections / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology; D014718:Vesico-Ureteral Reflux / Q000150:complications / Q000000981:diagnostic imaging; D014861:Washington / Q000453:epidemiology
D000900:Anti-Bacterial Agents