Quality indicators for appropriate antibiotic prescribing in urinary tract infections in children

Konstantinos Vazouras, Charlotte Jackson, Laura Folgori, Anastasia Anastasiou-Katsiardani, Yingfen Hsia*, Romain Basmaci

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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Abstract

Background
The aim of this study was to define a set of urinary tract infections (UTIs)-specific quality indicators for appropriate prescribing in children and evaluate clinical practices in a district general hospital in Greece.

Methods
The UTIs-specific quality indicators were informed by a review of the existing literature. Quality indicators were selected to describe the overall antibiotics use, prescribing patterns and UTIs clinical management regarding treatment and prophylaxis in a cohort of children admitted with a UTI. Microbiological, clinical and prescribing data about dosing, duration and route of administration were collected from the patients’ electronic health records.

Results
Twelve quality indicators were adapted or developed for prescribing in childhood UTIs. A broad variety of antibiotics were prescribed for UTIs, with a drug utilization (DU) 90% rate of 6 and 9 different antibiotics for febrile and afebrile UTIs, respectively. Despite the low incidence of multi-drug resistant UTIs in the study period (9/261, 3.4%), broad-spectrum antibiotics were prescribed in 33.5% (164/490) of prescriptions. A total of 62.8% (164/261) of patients were started on empiric combined therapies, while opportunities to de-escalate were missed in 37.8% (62/164) of them. One quarter (67/261, 25.7%) of patients did not fulfil the criteria for receiving treatment, while nearly half of those prescribed prophylaxis (82/175, 46.9%) could have avoided having a prophylaxis prescription.

Conclusions
Our study identified substantial gaps for improvement in antimicrobial prescribing for UTIs in children. The application of the proposed quality indicators could help to limit unnecessary antibiotics use in children with UTI.

Original languageEnglish
Article number400
Number of pages10
JournalBMC Infectious Diseases
Volume23
DOIs
Publication statusPublished - 12 Jun 2023

Keywords

  • Antimicrobial stewardship
  • Urinary tract infections
  • Children
  • Antibiotics
  • Appropriate prescribing
  • Quality indicators

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