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首页> 外文期刊>The Journal of pharmacy technology: jPT : official publication of the Association of Pharmacy Technicians >Analysis of Community-Acquired Urinary Tract Infection Treatment in Pediatric Patients Requiring Hospitalization: Opportunity for Use of Narrower Spectrum Antibiotics
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Analysis of Community-Acquired Urinary Tract Infection Treatment in Pediatric Patients Requiring Hospitalization: Opportunity for Use of Narrower Spectrum Antibiotics

机译：儿科患者患有社区尿路感染治疗的分析：使用较窄频谱抗生素的机会

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Background: The most narrow-spectrum antibiotic possible should be used for empiric and definitive treatment of pediatric urinary tract infections (UTIs). Objectives: The objectives of this study were to determine an appropriate narrow-spectrum antibiotic for empiric UTI treatment, factors differentiating empiric first-generation cephalosporin (FGC) versus third-generation cephalosporin (TGC) coverage, and factors associated with unnecessarily broad-spectrum definitive antibiotic treatment. Methods: This was a retrospective chart review of children admitted from 2013 to 2015 who were diagnosed with a UTI and received treatment. Multivariable logistic regression assessed independent factors associated with our outcomes. Results: Of 568 diagnosed UTIs, 88.6% received empiric TGC treatment. Empiric coverage among cultured organisms was only 5.4% lower in FGC versus TGC. Adolescent age group (odds ratio [OR] = 8.83, 95% confidence interval [CI] = 1.47-53.11), uncircumcised males (OR = 4.52, 95% CI = 1.27-16.08), Hispanic ethnicity (OR = 4.37, 95% CI = 1.14-16.82), and hospitalization within the preceding 3 months (OR = 4.73, 95% CI = 1.38-16.23) were associated with FGC nonsusceptibility among TGC susceptible Enterobacteriaceae pathogens. De-escalation occurred in 55.8% of diagnosed UTIs eligible for de-escalation at discharge. Urine white blood cell (WBC) count >5 (OR = 2.89, 95% CI = 1.14-7.21), serum WBC count (OR = 1.04, 95% CI = 1.01-1.07), and having only one narrow-spectrum treatment option (OR = 5.1, 95% CI = 2.43-10.66) were associated with unnecessarily broad-spectrum definitive treatment. Conclusion and Relevance: FGC would be an appropriate narrow-spectrum empiric agent for UTIs at our institution. The factors associated with FGC nonsusceptibility can further stratify empiric treatment decisions. The factors associated with unnecessarily broad-spectrum definitive treatment illustrate areas for educational efforts and future research regarding UTI treatment.
机译：背景：对于儿童尿路感染（UTI）的经验性和确定性治疗，应尽可能使用最窄谱的抗生素。目的：本研究的目的是确定适合经验性UTI治疗的窄谱抗生素，区分经验性第一代头孢菌素（FGC）和第三代头孢菌素（TGC）覆盖范围的因素，以及与不必要的广谱确定性抗生素治疗相关的因素。方法：这是对2013年至2015年确诊为UTI并接受治疗的儿童的回顾性图表回顾。多变量逻辑回归评估了与我们的结果相关的独立因素。结果：在568例确诊的UTI中，88.6%接受经验性TGC治疗。在培养生物中，FGC的经验覆盖率仅比TGC低5.4%。青少年年龄组（优势比[OR]=8.83，95%可信区间[CI]=1.47-53.11），未经割礼的男性（OR=4.52，95%可信区间=1.27-16.08），西班牙裔种族（OR=4.37，95%可信区间=1.14-16.82），以及前3个月内住院（OR=4.73，95%可信区间=1.38-16.23）与TGC易感肠杆菌科病原体中FGC不敏感相关。55.8%的确诊UTI在出院时有资格降级。尿白细胞（WBC）计数>5（OR=2.89，95%CI=1.14-7.21）、血清WBC计数（OR=1.04，95%CI=1.01-1.07）和只有一种窄谱治疗选择（OR=5.1，95%CI=2.43-10.66）与不必要的广谱确定性治疗相关。结论和相关性：FGC将是我们研究所治疗UTI的一种合适的窄谱经验性药物。与FGC不敏感相关的因素可以进一步分层经验性治疗决定。与不必要的广谱确定性治疗相关的因素说明了有关UTI治疗的教育努力和未来研究领域。

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