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Pediatrician Compliance with the American Academy of Pediatrics Guidelines on Infant UTI.
Karl Coutinho, MD1, Kristian Stensland, BA2, Soo Kim, BA2, Ardavan Akhavan, MD3, Jeffrey Stock, MD1.
1Mount Sinai Hospital, New York, NY, USA, 2Mount Sinai School of Medicine, New York, NY, USA, 3Seattle Children’s Hospital, Seattle, WA, USA.

Background: The American Academy of Pediatrics (AAP) guidelines on the diagnosis and management of urinary tract infections (UTIs) discourages the use of bagged urine specimens for the workup of febrile UTIs in children aged 2-24 months. Despite these guidelines, bagged urine collection is commonplace among providers. We report the results of a survey assessing urine collection preferences among physicians registered with the AAP to gauge whether these preferences are related to a variety of physician demographics such experience, practice type, and fellowship training.
Methods: A 29 question survey was emailed to all registered members of the NJ Chapter of the AAP with SurveyMonkey. Respondents not treating pediatric patients were excluded. Practitioners were questioned on their preferred method of urine collection in hypothetical infants with varying number of risk factors for UTI, as defined by the AAP guidelines. Chi-square and Fisher Exact tests were used to compare demographic variables with urine collection preferences and compliance with the 2011 AAP guidelines on the management of febrile UTIs in infants and young children.
Results: Of 160 respondents, 155 (97%) were eligible for participation. 39% were in practice for 20 years or more, and 58% were female. 77% of respondents were in private practice; 45% had at least a part time academic affiliation. 37 (24%) were fellowship trained, most frequently subspecializing in infectious disease (16%), emergency medicine (16%) and endocrinology (11%). 62% of respondents considered themselves familiar with the 2011 AAP UTI guidelines for infants. Not considering risk factors, 47% of respondents recommended urethral catheterization for urine culture, 8% recommended a bagged specimen only for culture, 8% catheterization or suprapubic aspiration pending a positive bagged urinalysis, and 35% said selection would depend on the clinical scenario/temperament of the parents. In febrile, uncircumcised males with 1 – 4 risk factors, 7 – 3% of respondents preferred bagged urine specimens, respective to increasing number of risk factors. In circumcised boys, 16 – 5% preferred bagged specimens, respectively. In febrile females with 1 – 4 risk factors for UTI, a bagged specimen was preferred by 10 – 2% of respondents, respectively. There was no significant relationship between preference for bagged specimens and respondent age (p=0.59), gender (p=0.80), years in practice (p= 0.13), fellowship training (p= 0.19), academic affiliation (p=0.84), or perceived familiarity with the 2011 AAP guidelines (p=0.90).
Conclusions: Despite recent guidelines discouraging the use of bagged urine specimens in the workup of UTIs in febrile children aged 2-24 months, up to 16% of pediatric practitioners prefer bagged specimens over more sterile methods such as catheterization or suprapubic aspiration. These specimens may result in higher false positive rates in the detection and treatment of febrile UTIs. Surprisingly, demographic variables were not associated with compliance with the guidelines. Further research should be done to better assess way to change these practice patterns which differ from current AAP guidelines.


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