title: Urine Culture Follow-up and Antimicrobial Stewardship in a Pediatric Urgent Care Network.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Pediatrics.
authors.forename: Dipanwita
authors.initials: D
authors.lastname: Saha
authors.affiliation: Department of Pediatrics.
authors.forename: Jimisha
authors.initials: J
authors.lastname: Patel
authors.affiliation: Quality Improvement Services, and.
authors.forename: Don
authors.initials: D
authors.lastname: Buckingham
authors.affiliation: Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio.
authors.forename: David
authors.initials: D
authors.lastname: Thornton
authors.affiliation: Department of Pediatrics.
authors.forename: Terry
authors.initials: T
authors.lastname: Barber
authors.affiliation: Department of Pediatrics, joshua.watson@nationwidechildrens.org.
authors.forename: Joshua R
authors.initials: JR
authors.lastname: Watson
mesh_terms: D000553:Ambulatory Care / Q000706:statistics & numerical data; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D002648:Child; D005500:Follow-Up Studies; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D058996:Quality Improvement; D016482:Urinalysis / Q000379:methods; D014552:Urinary Tract Infections / Q000175:diagnosis* / Q000188:drug therapy; D014556:Urine / Q000382:microbiology*
chemical_list: D000890:Anti-Infective Agents