Stephanie W Hum1, Nader Shaikh2. 1. University of Pittsburgh School of Medicine, Pittsburgh, PA; Division of General Academic Pediatrics, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA. 2. University of Pittsburgh School of Medicine, Pittsburgh, PA; Division of General Academic Pediatrics, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA. Electronic address: nader.shaikh@chp.edu.
Abstract
OBJECTIVES: To identify factors associated with delayed antimicrobial treatment in febrile children with urinary tract infection (UTI). STUDY DESIGN: We reviewed data from 802 children with UTI enrolled in 2 previously conducted prospective studies (Randomized Intervention for Children with Vesicoureteral Reflux and Careful Urinary Tract Infection Evaluation) and extracted data on possible predictors of delayed treatment including age, sex, history of UTI, ethnicity, race, primary caregiver's education level, insurance, and income. We used univariate and multivariable analyses to investigate the relationship between these predictors and treatment delay. RESULTS: We included 660 febrile patients with a mean age of 17.0 months old. Older age and commercial insurance were associated with delayed treatment on univariate analysis. Compared with younger children, treatment was delayed by an average of 26.2 hours in children ≥12 months of age. This relationship remained significant on multivariable analysis. Treatment also was delayed by an average of 12.6 hours in patients with commercial insurance. Race, ethnicity, primary caregiver's education level, and income were not associated with delayed treatment. CONCLUSIONS: Older age was a consistent predictor of delayed antimicrobial treatment. Delays in the initiation of antimicrobial therapy for UTI has previously been associated with renal scarring. Educating parents with older children regarding the management of fever as well as providers regarding prompt evaluation and management may help to reduce renal scarring.
RCT Entities:
OBJECTIVES: To identify factors associated with delayed antimicrobial treatment in febrile children with urinary tract infection (UTI). STUDY DESIGN: We reviewed data from 802 children with UTI enrolled in 2 previously conducted prospective studies (Randomized Intervention for Children with Vesicoureteral Reflux and Careful Urinary Tract Infection Evaluation) and extracted data on possible predictors of delayed treatment including age, sex, history of UTI, ethnicity, race, primary caregiver's education level, insurance, and income. We used univariate and multivariable analyses to investigate the relationship between these predictors and treatment delay. RESULTS: We included 660 febrile patients with a mean age of 17.0 months old. Older age and commercial insurance were associated with delayed treatment on univariate analysis. Compared with younger children, treatment was delayed by an average of 26.2 hours in children ≥12 months of age. This relationship remained significant on multivariable analysis. Treatment also was delayed by an average of 12.6 hours in patients with commercial insurance. Race, ethnicity, primary caregiver's education level, and income were not associated with delayed treatment. CONCLUSIONS: Older age was a consistent predictor of delayed antimicrobial treatment. Delays in the initiation of antimicrobial therapy for UTI has previously been associated with renal scarring. Educating parents with older children regarding the management of fever as well as providers regarding prompt evaluation and management may help to reduce renal scarring.
Authors: Alejandro Hoberman; Saul P Greenfield; Tej K Mattoo; Ron Keren; Ranjiv Mathews; Hans G Pohl; Bradley P Kropp; Steven J Skoog; Caleb P Nelson; Marva Moxey-Mims; Russell W Chesney; Myra A Carpenter Journal: N Engl J Med Date: 2014-05-04 Impact factor: 91.245
Authors: Nader Shaikh; Jonathan C Craig; Maroeska M Rovers; Liviana Da Dalt; Stefanos Gardikis; Alejandro Hoberman; Giovanni Montini; Carlos Rodrigo; Seppo Taskinen; David Tuerlinckx; Timothy Shope Journal: JAMA Pediatr Date: 2014-10 Impact factor: 16.193
Authors: Nader Shaikh; Timothy R Shope; Alejandro Hoberman; Gysella B Muniz; Sonika Bhatnagar; Andrew Nowalk; Robert W Hickey; Marian G Michaels; Diana Kearney; Howard E Rockette; Martin Charron; Ruth Lim; Massoud Majd; Eglal Shalaby-Rana; Marcia Kurs-Lasky; Daniel M Cohen; Ellen R Wald; Greg Lockhart; Hans G Pohl; Judith M Martin Journal: Pediatr Nephrol Date: 2020-06-15 Impact factor: 3.714