The Impact of a UTI Pathway Bundle on Antibiotic Prescribing for Pediatric Urinary Tract Infections Through the Lens of Health Equity in Two Emergency Departments within a Children’s Hospital System
Authors: Wallace Meagan A , Simmons Pilar G , Maples Holly D 
Published: January 2025

Abstract

Corresponding Author: Holly D. Maples, 1 Children’s Way, Slot 208, 501-658-6796, maplesholly@uams.edu
Alternate Corresponding Author: Meagan A. Wallace, 1 Children’s Way, Slot 208 02, 501-424-7208, mwallace3@uams.edu
Acknowledgements: Jeff and Kathy Lewis Sanders Distinguished Chair in Pediatrics Endowment
No conflicts of Interest.

Background
Recognition and treatment of pediatric urinary tract infections (UTIs) with proper antibiotics and duration are essential to prevent further complications and to combat antimicrobial resistance. Antibiotic prescribing in other pediatric infections has been found to be impacted by patient-related factors including socioeconomic and ethnic minority status. Four years ago, an educational activity was introduced in both emergency departments in the system that introduced cephalexin as our preferred first line treatment but was never formally expanded to other locations. Recently, a bundle of strategies including a UTI pathway and dynamic order set, UTI antibiogram, and education with a focus on duration was introduced to all inpatient locations. Cephalexin utilization has remained highly utilized since initial education in both emergency departments, however evaluation of antibiotic utilization by health disparities and duration were not assessed. This quality improvement project evaluates antibiotic selection and duration pre- and post-implementation in both emergency departments.

Methods
This was a retrospective analysis of pediatric patients &lt;19 years of age who were diagnosed with a UTI and discharged from either emergency department within the system with an antibiotic. The UTI bundle was implemented in July 2023 and pre-implementation data was collected from January 2022 through June 2023 and post-implementation data was collected from July 2023 to December 2023. Data included patient demographics, provider type, location, allergies, antibiotic dose and duration, and immunization status. Reported patient demographics included age, gender, weight, race, ethnicity, payor status, language, and zip code. Race was divided into black, white, and other including mixed races and those not reported. All data analyses were conducted in Wizard 2.0 (version 2.0.14).

Results
Cephalexin utilization remained consistent in the post utilization period that accounted for approximately 80% of antibiotic prescriptions for both emergency departments. No significant differences were found based on race, language, or payor status. ED #2 had a significant improvement in utilization based on gender. (Table 1.) Improvement was seen in both ED’s for 5-day duration. However, an increase in both 7- and 10-day was seen in ED #1 while ED #2 saw a significant decline in 10-day duration. (Table 1)
TABLE 1.

Conclusion
Despite the same intervention in two locations, differences among prescribing habits were found. Further work to continue improving duration in the emergency department can include developing a discharge smart set, assessing the need for individual education, and/or provider report cards.