title: Use of urine testing in outpatients treated for urinary tract infection.
abstract: OBJECTIVE
  To characterize urine test use in ambulatory, antibiotic-treated pediatric urinary tract infection (UTI).
  
  
  METHODS
  We studied children <18 years who had an outpatient UTI and a temporally associated antibiotic prescription from 2002 through 2007 by using a large claims database, Innovus i3. We evaluated urine-testing trends and performed multivariable logistic regression to assess for factors associated with urine culture use.
  
  
  RESULTS
  Of 40 603 treated UTI episodes in 28 678 children, urinalysis was performed in 76%, and urine culture in 57%; 32% of children <2 years had no urinalysis or culture performed for an antibiotic-treated UTI episode. Urine culture use decreased during the study period from 60% to 54% (P < .001). We observed variation in urine culture use with age (<2 years: odds ratio [OR] 1.0, 95% confidence interval [CI] 0.9-1.1; 2-5 years: OR 1.3, 95% CI 1.2-1.4; 6-12 years: OR 1.3, 95% CI 1.2-1.4, compared with 13-17 years); gender (boys: OR 0.8, 95% CI 0.8-0.9); and specialty (pediatrics: OR 2.6, 95% CI 2.5-2.8; emergency medicine, OR 1.2, 95% CI 1.1-1.3; urology: OR 0.5, 95% CI 0.4-0.6, compared with family/internal medicine). Recent antibiotic exposure (OR 1.1, 95% CI 1.1-1.2) and empirical broad-spectrum prescription (OR 1.2, 95% CI 1.1-1.2) were associated with urine culture use, whereas previous UTI and urologic anomalies were not.
  
  
  CONCLUSIONS
  Providers often do not obtain urine tests when prescribing antibiotics for outpatient pediatric UTI. Variation in urine culture use was observed based on age, gender, and physician specialty. Additional research is necessary to determine the implications of empirical antibiotic prescription for pediatric UTI without confirmatory urine testing.
authors.affiliation: University of California, San Francisco, Department of Urology, San Francisco, CA 94130, USA. copphl@urology.ucsf.edu
authors.forename: Hillary L
authors.initials: HL
authors.lastname: Copp
authors.forename: Jenny H
authors.initials: JH
authors.lastname: Yiee
authors.forename: Alexandria
authors.initials: A
authors.lastname: Smith
authors.forename: Janet
authors.initials: J
authors.lastname: Hanley
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Saigal
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000900:Anti-Bacterial Agents / Q000145:classification / Q000627:therapeutic use*; D002140:California; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007223:Infant; D008297:Male; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data*; D012008:Recurrence; D012189:Retrospective Studies; D013223:Statistics as Topic; D016482:Urinalysis / Q000706:statistics & numerical data*; D014552:Urinary Tract Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000652:urine*; D014556:Urine / Q000382:microbiology*
chemical_list: D000900:Anti-Bacterial Agents
keywords: antibiotic prescription; pediatric; urinalysis; urinary tract infection; urine culture
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