Urinary Tract Infection Pathway Background and Objectives Urinary tract infection (UTI) is one of the most common causes of SBI (serious bacterial infection) in children aged 2-24 months, and a common reason for inpatient admission. The goal of this pathway is early treatment to help with elimination of infection and prevention of bacteremia. Early intervention will also help decrease recurrence and long-term complications including hypertension, renal scarring and impaired renal growth and function. In 2011, the American Academy of Pediatrics came out with new guidelines on how to assess and treat UTI in children aged 2-24 months. The objectives of this pathway are to: Decrease the variation in method of urine collection Improve accurate diagnosis of UTI using specific lab criteria Improve the use of appropriate antibiotic therapy in the inpatient and outpatient settings Standardize the use of renal bladder ultrasound for 1st time UTI Decrease use of voiding cysto-urethrogram (VCUG) as a first line imaging tool Outline appropriate follow up Algorithm Download Urinary Tract Infection Pathway Algorithm Quality Metrics Percentage of patients with use of UTI order site Percentage of patients age 2 to 24 month with 1st time UTI ordered for renal ultrasound Percentage of patients receiving VCUG Percentage of patients with first line antibiotic choice per pathway recommendations Percentage of patients with appropriately dose antibiotics per pathway Percentage of patients with total antibiotic course duration 7 to 14 days Monthly average duration of antibiotic courses Length of stay ED (minutes) and inpatient (days) Educational Module Download Urinary Tract Infection Educational Module Key References UTI Guideline Team, Cincinnati Children’s Hospital Medical Center: Evidence-based care guideline for medical management of first urinary tract infection in children 12 years of age or less http://www.cincinnatichildrens.org/svc/dept-div/health-policy/ev-based/uti.htm, Guideline 7, pages 1-23, November, 2006. Reaffirmation of AAP Clinical Practice Guideline: The Diagnosis and Management of the Initial Urinary Tract Infection in Febrile Infants and Young Children 2-24 Months of Age. 2016 Dec;138(6). Cheng EY, Prasad MM. Radiographic Evaluation of Children with Febrile Urinary Tract Infection; Bottom-Up, Top-Down or None of the Above? Adv Urol. 2012;2012:716-39. Montini G, Tullus K, Hewitt I. Febrile Urinary Tract Infections in Children. N Engl J Med. 2011 July;365(3):239-50. Pathway Contacts Kara Denz Fluck, PAC Marta Neubauer, MD Disclaimer The clinical pathways in the above links have been developed specifically for use at Connecticut Children’s and are made available publicly for informational and/or educational purposes only. The clinical pathways are not intended to be, nor are they, a substitute for individualized professional medical judgment, advice, diagnosis, or treatment. Although Connecticut Children’s makes all efforts to ensure the accuracy of the posted content, Connecticut Children’s makes no warranty of any kind as to the accuracy or completeness of the information or its fitness for use at any particular facility or in any individual case. View all Clinical Pathways >
