Urinary tract infections (UTIs) are among the most common bacterial infections in infants and young children. When a child develops symptoms such as fever, clinicians must determine whether and how to evaluate for a UTI and decide on appropriate management. Despite how frequently these infections occur, important questions remain about how UTIs should be diagnosed and managed in early childhood.
Dr. Marie Wang of the Stanford University School of Medicine is leading a study aimed at improving the diagnosis and care of UTIs in young children. With support from a $350,000, three-year Gerber Foundation major research grant, Dr. Wang and her team will analyze more than a decade of healthcare data from Kaiser Permanente Northern California, a large integrated health system, to better understand patterns in UTI diagnosis, imaging practices, and patient outcomes.
In 2011, the American Academy of Pediatrics introduced updated guidelines recommending stricter diagnostic criteria and a more selective approach to imaging tests that evaluate the urinary tract. These guidelines are now retired and new ones are under development, however controversies persist regarding these recommendations, and questions remain about how consistently they are applied in clinical practice.
“There is still significant variability in how UTIs are diagnosed and managed in young children, and we continue to see evidence of both misdiagnosis and overtreatment,” said Dr. Wang. “Our goal is to generate meaningful evidence that helps clinicians make more informed decisions and ultimately improve care for young patients.”
Dr. Wang’s study directly addresses these questions.
Using electronic health record data from Kaiser Permanente Northern California, the research team will analyze records from approximately 135,000 children ages 0 to 2 years over a 14-year period following the introduction of the guidelines. The study will characterize patterns in UTI diagnosis to help inform optimal diagnostic criteria, investigate how imaging and preventive antibiotic use are associated with health outcomes, and examine how atypical UTIs are managed.
“This study will enhance our understanding of diagnosis and imaging patterns for pediatric UTI,” said Dr. Wang. “We hope the findings will help us understand if use of stricter diagnostic criteria and more selective imaging resulted in changes in patient outcomes.”
The study will examine whether stricter diagnostic criteria contributed to fewer UTI diagnoses without increasing UTI hospitalizations. Researchers will also evaluate how often children undergo imaging tests after a UTI diagnosis and how outcomes changed over time. Finally, the team will explore how UTIs caused by atypical bacteria are managed in order to help clinicians better identify children who may benefit from additional imaging. Taken together, these findings may help inform more targeted, evidence-based care for young children with UTIs and provide greater clarity for clinicians and families.
