Physician Preferences Surrounding UTI Management in Young Infants

Introduction Variability exists in the treatment of young infants with urinary tract infection (UTI). Many infants are hospitalized for IV antibiotics well beyond clinical recovery. We designed a vignette survey to examine... [ view full abstract ]

Introduction

Variability exists in the treatment of young infants with urinary tract infection (UTI). Many infants are hospitalized for IV antibiotics well beyond clinical recovery. We designed a vignette survey to examine variability in physician preference for intravenous (IV) antibiotic duration, genitourinary imaging, and prophylactic antibiotics and to evaluate drivers of resource utilization.

Methods

A national case vignette survey was conducted of pediatricians sampled from the American Medical Association’s Physician MasterFile. Respondents were provided a case of a 2-week old infant female with febrile UTI, and asked to indicate preferences for IV antibiotic duration and to rank drivers of this decision. Respondents were additionally asked whether they would obtain a voiding cystourethrogram (VCUG) and, regardless of preference, were randomly presented either a normal result or bilateral grade II vesicoureteral reflux (VUR).

Results

The survey was e-mailed to 3528 physicians; 279 out of 438 opened surveys (63.7%) were completed. Preference for total IV antibiotic duration differed significantly (P < 0.001) across specialty, with a median total IV duration of 2 total days (0 additional days) for general pediatrics/hospitalists, 7 days for neonatology, and 5 days for infectious disease. No other demographic factors predicted IV duration. Drivers for this decision are depicted in Table 1. Fifty-three percent (n = 148) of respondents wanted a VCUG f. Among respondents (n=131) who did not want a VCUG, 24/61 (39%) would prescribe prophylactic antibiotics when the VCUG demonstrated grade II VUR, versus 0/70 when the VCUG was normal.

Discussion

In this survey of pediatricians, specialty was the most influential driver of IV antibiotic duration. Many physicians who initially expressed a preference against ordering additional imaging planned to prescribe prophylactic antibiotics when the results were abnormal thus even unwanted diagnostic test results drive treatment decisions.