title: [Management of urinary tract infections in children. Evaluation of clinical practice].
abstract: OBJECTIVE
  To determine the rate of therapeutic management satisfying the institutional protocol for children with urinary tract infection (UTI) in the context of the emergence of extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae.
  
  
  METHODS
  A retrospective, single-center, observational study was carried out for 1 year (2010-2011). Data from all children admitted to the emergency department with a diagnosis of UTI were analysed. Adherence to the protocol was evaluated for the initial management and at re-evaluation with the definitive result of the urine culture. Risk factors for nonadherence were analysed.
  
  
  RESULTS
  Among the children, 393 were included. An ESBL Enterobacteriaceae-related UTI was identified in 2.2% of urine analyses. The initial therapeutic management satisfied the protocol for 95% of children and at re-evaluation for 80%. Nonadherence was related to poorly adapted treatment (59%) and an erroneous indication of dual antibiotic therapy (20%). Variables associated with the inadequacy of the initial management were age less than 3 months (adjusted OR [aOR]: 9.3; 95%CI: 3.5-24.8) and at re-evaluation age under 3 months (aOR: 12.8; 95%CI: 5.5-29.9) and an unconfirmed infection in the final urine culture (aOR: 30.8; 14.7-64.3).
  
  
  CONCLUSIONS
  Adherence to the protocol was good but could be increased by a better re-evaluation procedure with the result of the urine culture. ESBL Enterobacteriaceae-related UTIs were still rare enough to influence the efficacy of management.
authors.affiliation: Urgences pédiatriques et maladies infectieuses, université Lille Nord-de-France, hôpital R.-Salengro, CHRU de Lille, 2, avenue Oscar-Lambret, 59000 Lille, France; Faculté de médecine, université Lille-2, UDSL, 59000 Lille, France.
authors.forename: S
authors.initials: S
authors.lastname: Bontemps
authors.affiliation: Urgences pédiatriques et maladies infectieuses, université Lille Nord-de-France, hôpital R.-Salengro, CHRU de Lille, 2, avenue Oscar-Lambret, 59000 Lille, France.
authors.forename: M
authors.initials: M
authors.lastname: Lagrée
authors.affiliation: Faculté de médecine, université Lille-2, UDSL, 59000 Lille, France; Laboratoire de microbiologie, université Lille Nord-de-France, CHRU de Lille, 59000 Lille, France.
authors.forename: R
authors.initials: R
authors.lastname: Dessein
authors.affiliation: Urgences pédiatriques et maladies infectieuses, université Lille Nord-de-France, hôpital R.-Salengro, CHRU de Lille, 2, avenue Oscar-Lambret, 59000 Lille, France.
authors.forename: A
authors.initials: A
authors.lastname: Maftei
authors.affiliation: Urgences pédiatriques et maladies infectieuses, université Lille Nord-de-France, hôpital R.-Salengro, CHRU de Lille, 2, avenue Oscar-Lambret, 59000 Lille, France; Faculté de médecine, université Lille-2, UDSL, 59000 Lille, France; EA2694, santé publique : épidémiologie et qualité des soins, université Lille-2, UDSL, 59000 Lille, France.
authors.forename: A
authors.initials: A
authors.lastname: Martinot
authors.affiliation: Urgences pédiatriques et maladies infectieuses, université Lille Nord-de-France, hôpital R.-Salengro, CHRU de Lille, 2, avenue Oscar-Lambret, 59000 Lille, France; Faculté de médecine, université Lille-2, UDSL, 59000 Lille, France; EA2694, santé publique : épidémiologie et qualité des soins, université Lille-2, UDSL, 59000 Lille, France. Electronic address: francois.dubos@chru-lille.fr.
authors.forename: F
authors.initials: F
authors.lastname: Dubos
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D005260:Female; D005602:France; D019983:Guideline Adherence; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010349:Patient Compliance; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D014552:Urinary Tract Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology*
chemical_list: D000900:Anti-Bacterial Agents