[Management of urinary tract infections in children. Evaluation of clinical practice]. / Évaluation des pratiques de prise en charge des infections urinaires de l'enfant.

ABSTRACT

OBJECTIVE: To determine the rate of therapeutic management satisfying the institutional protocol for children with urinary tract infection (UTI) in the context of the emergence of extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae. METHODS: A retrospective, single-center, observational study was carried out for 1 year (2010-2011). Data from all children admitted to the emergency department with a diagnosis of UTI were analysed. Adherence to the protocol was evaluated for the initial management and at re-evaluation with the definitive result of the urine culture. Risk factors for nonadherence were analysed. RESULTS: Among the children, 393 were included. An ESBL Enterobacteriaceae-related UTI was identified in 2.2% of urine analyses. The initial therapeutic management satisfied the protocol for 95% of children and at re-evaluation for 80%. Nonadherence was related to poorly adapted treatment (59%) and an erroneous indication of dual antibiotic therapy (20%). Variables associated with the inadequacy of the initial management were age less than 3 months (adjusted OR [aOR] 9.3; 95%CI 3.5-24.8) and at re-evaluation age under 3 months (aOR 12.8; 95%CI 5.5-29.9) and an unconfirmed infection in the final urine culture (aOR 30.8; 14.7-64.3). CONCLUSION: Adherence to the protocol was good but could be increased by a better re-evaluation procedure with the result of the urine culture. ESBL Enterobacteriaceae-related UTIs were still rare enough to influence the efficacy of management.