WIP 16 - Risk Factors for Need for Emergency Department Re-visit/Admit in Extended Spectrum Beta-Lactamase (ESBL) Urinary Tract Infections (UTIs) Treated with Discordant Antibiotics

Publication Number: WIP 16.7380

Lohita Kollipara, University of California, San Diego School of Medicine, La Jolla, CA, United States; Vanessa Tamas, Rady Children's Hospital San Diego, San Diego, CA, United States; Kathryn Hollenbach, University of California, San Diego School of Medicine, San Diego, CA, United States

Background: ESBL organisms are an increasing cause of community acquired UTI. Many children with ESBL UTI are discharged with discordant antibiotic treatment at ED discharge. This may result in the patient revisit or admission after discharge.

Objective: The primary aim of this study is to identify the rate and the risk factors associated with re-visit or admission for ESBL UTIs initially treated with discordant antibiotics. The secondary aim is to determine if ESBL UTIs have an increased rate of ED re-visit/admit compared to non ESBL UTIs. We hypothesize that age and underlying congenital abnormalities of the kidney or urinary tract (CAKUT) diagnoses will be associated with higher rates of ED re-visit or hospital admission.

Design/Methods: We retrospectively identified patients aged 3 months-18 years, from 1/1/2014 -12/31/2023, evaluated at Rady's Children’s Hospital ED, discharged with an ESBL UTI, and treated with a discordant antibiotic. UTIS were defined as a urine culture yielding ≥ 50,000 CFU/mL of a single urinary pathogen obtained by catheterization or ≥100,000 CFU/mL obtained by clean catch. ESBL uropathogens were defined by the Clinical and Laboratory Standards Institute (CLSI) as an increase ≥ 5 mmi n the zone of inhibition in the presence of clavulanic acid added to a ceftazidime disc.
Logistic regression identified the clinical risk factors between the two groups (repeat visit/admit vs continued outpatient management). Risk factors analyzed included: patient demographics, prior history of CAKUT and ESBL, symptoms, physical exam findings, UA and laboratory results.
The study was approved by our local Institutional Review Board (IRB) in February 2024. Data collection and abstraction will be completed in November 2024, and data analysis and the poster will be completed by February 1st, 2025.