Resident Phoenix Children's Hospital Phoenix, Arizona, United States
Background: Urinary tract infections (UTI) are one of the most common bacterial infections in children. A UTI is defined as pyuria (> 5 white blood cells per high-power field or positive leukocyte esterase) and a positive urine culture (> 50,000 colony forming units/mL of a uropathogen). Antibiotics are often prescribed prior to the results of urine cultures. Given about 50-60% will result in negative cultures, patients may unnecessarily be exposed to antibiotics. Objective: Primary
Objective: To evaluate effectiveness of a text message intervention to stop oral antibiotics for patients with negative urine cultures following emergency department (ED) or urgent care (UC) encounters. Secondary
Objective: To determine barriers to antibiotic de-escalation, antibiotic days saved, and persistent symptoms following antibiotic discontinuation. Design/Methods: Following a quality improvement initiative, patients identified as candidates for antibiotic discontinuation are sent a text message if urine cultures are negative. Within 72 hours from message delivery, a study personnel will conduct a phone survey to determine compliance with discontinuing antibiotics and assess any barriers to antibiotic discontinuation if they were not stopped. Participants include subjects age >60 days seen at Phoenix Children’s ED or UC facilities who were prescribed antibiotics for suspected UTI and found to have negative urine cultures. Exclusion criteria include patients with renal disease, severe comorbidities, neurogenic bladder, indwelling catheters or stents, previous antibiotics use within 72 hours, or antibiotics prescribed for other infections. Demographics, antibiotic prescription information, and survey responses will be summarized descriptively using mean, standard deviation, median, and range for continuous variables and frequencies and percentages for categorical variables. To determine whether the actual days on antibiotics were significantly less than the prescribed days, a paired t-test will be used with a one-sided hypothesis and a significance level of 0.05.
