Urinary Tract Infections in Children with Medical Complexity at Pediatric Post-Acute Care Facilities: Variability in Diagnosis and Treatment

SUMMARY Background This study aims to describe current practices in diagnosing and treating urinary tract infections (UTIs) and antimicrobial stewardship policies related to UTI management in children with medical complexity (CMC) admitted to pediatric post-acute care facilities (PPACFs). Methods We performed a retrospective, descriptive, multi-center study involving 12 PPACFs from January 2021 to December 2022. Data collected included: general facility demographics, patient characteristics of those with UTIs, UTI diagnostic criteria, symptoms, microbiology, and treatment. We also collected antimicrobial stewardship policies (ASP) and nursing education related to UTI prevention and urinary catheter practices. Results A total of 206 and 243 UTI events were reported in 2021 and 2022, respectively, for an overall rate of 0.73 UTIs per 1000 patient-days (95% CI 0.67-0.80), with significant variability in frequency and diagnostic criteria across facilities. Most urine cultures (92%) were obtained by straight catheterization, and almost all UTI events (96%) were symptomatic. The most common pathogens included Escherichia coli (49%) and Klebsiella species (20%); 27% of pathogens were multidrug-resistant organisms (MDRO). ASPs were present in 92% of facilities, with variable implementation of Center for Disease Control and Prevention (CDC)-recommended policies. Recurrent UTIs accounted for 40% of all UTI events; among recurrent events, the median interval from the preceding UTI was 53 days. Conclusions Our study highlights the need for standardized diagnostic criteria and treatment strategies for UTIs in medically complex inpatients in PPACFs.