title: Urinary Tract Infection and Antimicrobial Stewardship in the Emergency Department.
abstract: OBJECTIVE
  The aims of this study were to assess empiric antibiotic use for presumed urinary tract infection (UTI) in the emergency department (ED) and to determine how often urine culture results subsequently do not confirm the diagnosis.
  
  
  METHODS
  This study is a retrospective cohort study of patients aged 21 years or younger in the Nationwide Children's Hospital ED from May 1, 2012, to October 31, 2012, who had a urinalysis and urine culture performed and were discharged home with empiric antibiotic therapy for presumed UTI. Patients with known urinary tract anomaly or antibiotic use in the previous 7 days were excluded. Confirmed UTI was defined as pyuria (>5 white blood cells per high-power field or dipstick positive for leukocyte esterase) and a positive urine culture (≥50,000 colony-forming units/mL of a uropathogen).
  
  
  RESULTS
  Of the 175 enrolled patients, urine was obtained by clean catch in 138 (79%), catheterization in 35 (20%), first-pass void in 1 (0.6%), and undocumented method in 1 (0.6%). Pyuria was demonstrated in 164 patients (94%), but only 97 (55%) had a positive urine culture. The combination of pyuria and a positive urine culture confirmed UTI in 90 patients (51%). The most commonly prescribed antibiotics were cefdinir in 103 patients (59%), trimethoprim/sulfamethoxazole in 40 (23%), and ciprofloxacin in 23 (13%). The median duration of prescribed therapy was 10 days (interquartile range, 7-10 days). Treatment duration was correlated negatively with age (r = -0.53, P < 0.01).
  
  
  CONCLUSIONS
  The current management of suspected UTI in ED patients results in unnecessary antibiotic exposure, highlighting an important opportunity for outpatient antimicrobial stewardship efforts.
authors: Joshua R
authors: JR
authors: Watson
authors: Pablo J
authors: PJ
authors: Sánchez
authors: John David
authors: JD
authors: Spencer
authors: Daniel M
authors: DM
authors: Cohen
authors: David S
authors: DS
authors: Hains
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000073602:Antimicrobial Stewardship / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008297:Male; D009820:Ohio; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011776:Pyuria; D012189:Retrospective Studies; D016482:Urinalysis / Q000379:methods; D014552:Urinary Tract Infections / Q000175:diagnosis / Q000188:drug therapy*; D014556:Urine / Q000382:microbiology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents