Epidemiologic trends in pediatric urinary tract infections in United States emergency departments from 2016 to 2023
Year: 2025
Type: article
Study design: Observational Study
Abstract: OBJECTIVE: Urinary tract infections are a common consideration when assessing pediatric patients with fever. With rising resistance rates and increased focus on antibiotic stewardship, current management needs to be better understood. This study reports the incidence and antibiotic distribution in a nationwide cohort of pediatric emergency department (ED) patients with cystitis and pyelonephritis during an 8-year period. METHODS: We performed a cohort study from January 1, 2016, to December 31, 2023, using Epic Cosmos data. Pediatric ED patients (<18 years) with an ICD-10 code corresponding to cystitis or pyelonephritis were included. The outcomes were the total number of ED presentations, outpatient antibiotic prescriptions, and antibiotics administered in the ED for patients admitted with cystitis or pyelonephritis. Binary logistic regression models were used to measure the relationship between the year and the dependent variables. RESULTS: Among 46,774,814 total pediatric ED visits, 720,863 (1.5%) were for cystitis, and 82,717 (0.2%) were for pyelonephritis. Among those admitted, the most common antibiotics were third-generation cephalosporins (cystitis, 55.6%; pyelonephritis, 62.3%), first-generation cephalosporins (cystitis, 13.8%; pyelonephritis, 13.7%), and ampicillin (cystitis, 10.8%; pyelonephritis, 6.6%). First-generation cephalosporin use rose over time, while ampicillin and ciprofloxacin use declined. Among discharged patients, the most common antibiotics were first-generation cephalosporins (cystitis, 43.1%; pyelonephritis, 33.7%), third-generation cephalosporins (cystitis, 20.8%; pyelonephritis, 25.8%), and trimethoprim-sulfamethoxazole (cystitis, 13.5%; pyelonephritis, 11.7%). First-generation cephalosporin use rose over time, while trimethoprim-sulfamethoxazole and ciprofloxacin use declined. Among those with cystitis specifically, the use of third-generation cephalosporins declined over time. CONCLUSION: Cystitis and pyelonephritis remain common ED presentations, representing nearly 2% of all pediatric ED visits, and antibiotic selection has shifted notably over time. Understanding the current epidemiology can inform public health planning and antibiotic stewardship in the ED.
DOI: 10.15441/ceem.25.055
Authors: Michael Gottlieb, Tamara Amponsah, Nhat Nguyen, Ohm Shukla, Kyle Bernard, Eric Moyer
Institutions: Rush University Medical Center, Rush University
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4409968877