Published online June 1, 2005
PEDIATRICS Vol. 115 No. 6 June 2005, pp. 1474-1478 (doi:10.1542/peds.2004-1559)
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Compliance With Guidelines for the Medical Care of First Urinary Tract Infections in Infants: A Population-Based Study

Adam L. Cohen, MD*,{ddagger}, Frederick P. Rivara, MD, MPH*,{ddagger},§, Robert Davis, MD, MPH*,§,|| and Dimitri A. Christakis, MD, MPH*,{ddagger}

* Department of Pediatrics
§ Department of Epidemiology
{ddagger} Department of Child Health Institute and Children's Hospital and Regional Medical Center, University of Washington, Seattle, Washington
|| Office of Genomics, Centers for Disease Control and Prevention, Atlanta, Georgia

Background. No population-based studies have examined the degree to which practice parameters are followed for urinary tract infections in infants.

Objective. To describe the medical care of children in their first year of life after a first urinary tract infection.

Methods. Using Washington State Medicaid data, we conducted a retrospective cohort study of children with a urinary tract infection during their first year of life to determine how many of these children received recommended care based on the most recent guidelines from the American Academy of Pediatrics. Recommended care included timely anatomic imaging, timely imaging for reflux, and adequate antimicrobial prophylaxis. Multivariate logistic-regression models were used to evaluate if hospitalization for first urinary tract infection, young age at time of diagnosis, gender, race, primary language of parents, having a managed care plan, and rural location of household residence were associated with recommended care.

Results. Less than half of all children diagnosed with a urinary tract infection in their first year of life received the recommended medical care. Children who were hospitalized for their first urinary tract infection were significantly more likely than children who were not hospitalized to receive anatomic imaging (relative risk [RR]: 1.38; 95% confidence interval [CI]: 1.20–1.57) and imaging for reflux (RR: 1.62; 95% CI: 1.34–1.90).

Conclusions. There is poor compliance with guideline-recommended care for first urinary tract infections in infants in a Medicaid population. Given the trend toward increased outpatient management of urinary tract infections, increased attention to outpatient imaging may be warranted.

Key Words: urinary tract infections • practice parameters/guidelines • Medicaid • population-based studies

Abbreviations: ICD-9-CM, International Classification of Diseases, Ninth Revision, Clinical Modification • CPT-4, Current Procedural Terminology, Fourth Revision • RR, relative risk • CI, confidence interval

Accepted Oct 19, 2004.


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