Daniel P Gorski1, Adam S Bauer1, Nina S Menda1, Matthew W Harer2. 1. Division of Neonatology, Department of Pediatrics, University of Wisconsin, Madison, WI, USA. 2. Division of Neonatology, Department of Pediatrics, University of Wisconsin, Madison, WI, USA. mwharer@wisc.edu.
Abstract
BACKGROUND: The pediatric definition of bacterial urinary tract infection (UTI) is >50,000 colony forming units (CFU) of a single organism on catheterized culture or 10,000-50,000 CFU with pyuria on urinalysis. LOCAL PROBLEM: The diagnosis of UTI in our NICU is clinician-dependent and not based on the accepted pediatric definition. METHODS: A retrospective review of positive urine cultures between 2015 and 2017 was performed. INTERVENTION: A treatment guideline for positive urine cultures was adopted and PDSA methodology utilized for incremental improvements. RESULTS: For 909 pre-intervention neonates, 26 of 38 positive urine cultures were treated for UTI but only 23% (6/26) met the pediatric definition. For 644 post-guideline neonates, only 7 of 25 positive urine cultures were treated and 86% met guideline criteria with no increase in urosepsis. CONCLUSIONS: A guideline to treat positive urine cultures resulted in a decreased rate of UTI diagnosis and thus prevented unnecessary antibiotic exposure.
BACKGROUND: The pediatric definition of bacterial urinary tract infection (UTI) is >50,000 colony forming units (CFU) of a single organism on catheterized culture or 10,000-50,000 CFU with pyuria on urinalysis. LOCAL PROBLEM: The diagnosis of UTI in our NICU is clinician-dependent and not based on the accepted pediatric definition. METHODS: A retrospective review of positive urine cultures between 2015 and 2017 was performed. INTERVENTION: A treatment guideline for positive urine cultures was adopted and PDSA methodology utilized for incremental improvements. RESULTS: For 909 pre-intervention neonates, 26 of 38 positive urine cultures were treated for UTI but only 23% (6/26) met the pediatric definition. For 644 post-guideline neonates, only 7 of 25 positive urine cultures were treated and 86% met guideline criteria with no increase in urosepsis. CONCLUSIONS: A guideline to treat positive urine cultures resulted in a decreased rate of UTI diagnosis and thus prevented unnecessary antibiotic exposure.
Authors: Eirin Esaiassen; Jon Widding Fjalstad; Lene Kristine Juvet; John N van den Anker; Claus Klingenberg Journal: J Antimicrob Chemother Date: 2017-07-01 Impact factor: 5.790