Medical Professional Publications

Urinary Tract Infections in Kids Can Be Complicated and Costly

Although commonly considered an uncomplicated illness, urinary tract infections are a leading cause of infection-related hospitalization in U.S. kids, trailing close behind respiratory infections such as pneumonia and bronchiolitis, according to a new study from Nationwide Children’s Hospital. Daily hospital costs for these patients are on the rise.

A urinary tract infection (UTI) is a bacterial infection that affects any part of the urinary tract; these infections are routinely treated with an antibiotic regimen in children. “Urinary tract infections are one of the most common bacterial infections in pediatrics,” said David Hains, MD, principal investigator in the Center for Clinical and Translational Research at The Research Institute at Nationwide Children’s and one of the study authors. “Although most urinary tract infections are uncomplicated, some children require hospitalization and inpatient management.”

To evaluate the socioeconomic impact of pediatric UTIs in the United States, Nationwide Children’s faculty used a national database representing a sample of pediatric discharges from up to 4,000 community hospitals to examine records of children under 18 years old who were admitted to a hospital for UTI in 2000, 2003 and 2006.

They found that UTIs were one of the most common pediatric admission diagnoses during the time period. “When comparing the number of admissions for UTIs with the number of admissions for the most common infection-related diagnoses in the national database, annual UTI admissions do not trail far behind admissions for respiratory infections including pneumonia and bronchiolitis or soft tissue infections,” said John David Spencer, MD, Nephrology fellow at Nationwide Children’s and the study’s lead author. Girls and children less than 1 year of age were nearly two-and-a-half times more likely to require inpatient care for the infection.

The study also showed that although admission rates and length of stay have remained fairly consistent over the last decade, hospital charges for inpatient UTI management have increased disproportionate to hospital costs. “From 2000 to 2006, hospital bills for UTI increased from $6,279 to $10,489 per hospitalization, representing a 67 percent increase,” said Dr. Spencer. “These findings emphasize the need for continued research in the area of cost-effective strategies for the management of pediatric UTIs.”  The study authors suggest that new research findings support modifications in care that could potentially reduce costs for pediatric UTI care including: increased dependence on outpatient management, more appropriate use of oral antibiotic therapy instead of more expensive parenteral therapy, limiting unnecessary use of prolonged courses of antibiotics, and minimizing use of prophylactic antibiotics.

“Our data confirm that the socioeconomic burden of pediatric UTIs is large and increasing at a rapid rate in the United States,” said Dr. Spencer. “In an attempt to offset rising hospital charges for UTI admissions, physicians should aim to promptly recognize, evaluate and appropriately treat a suspected UTI.”

Spencer JD, Schwaderer A, McHugh K, Hains DS. Pediatric urinary tract infections: an analysis of hospitalizations, charges, and costs in the USA. Pediatr Nephrol. 2010 Aug 14. [Epub ahead of print]

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