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Pediatric urinary tract infections: an analysis of hospitalizations, charges, and costs in the USA

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Abstract

This study evaluates the impact of pediatric uninary tract infection (UTI)s on the economy and inpatient healthcare utilization in the USA. A retrospective analysis of patient demographics and hospital economics was performed on children less than 18 years of age admitted with a UTI between 2000 and 2006 using the Healthcare Cost and Utilization Project Kids’ Inpatient Database. Our results were stratified as follows. Hospital admissions—nearly 50,000 children/year were admitted with a UTI. Pediatric UTIs represented 1.8% of all pediatric hospitalizations. Seventy-three percent of patients were female and 40% were under 1 year of age. Payer information—from 2000 to 2006, pediatric insurance coverage shifted from the private sector to the public sector. Hospital cost—in 2000, estimated hospital costs for UTIs were $2,858 per hospitalization and rose to $3,838 by 2006. Mean hospital charges increased from $6,279 to $10,489 per stay. By 2006, aggregate hospital charges exceeded $520 million. Our results indicate that UTIs are among the most common pediatric admission diagnoses. Hospitalization is more common in females and younger children. Since 2000, hospital charges for UTIs increased disproportionately to hospital costs. Over time, more children hospitalized with a UTI depend on public agencies to cover healthcare expense. More efforts are needed to evaluate cost-effective strategies for evaluation and treatment of UTIs.

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References

  1. Bachur RG, Harper MB (2001) Predictive model for serious bacterial infections among infants younger than 3 months of age. Pediatrics 108:311–316

    Article  CAS  PubMed  Google Scholar 

  2. Byington CL, Rittichier KK, Bassett KE, Castillo H, Glasgow TS, Daly J, Pavia AT (2003) Serious bacterial infections in febrile infants younger than 90 days of age: the importance of ampicillin-resistant pathogens. Pediatrics 111:964–968

    Article  PubMed  Google Scholar 

  3. Purcell K, Fergie J (2002) Concurrent serious bacterial infections in 2396 infants and children hospitalized with respiratory syncytial virus lower respiratory tract infections. Arch Pediatr Adolesc Med 156:322–324

    PubMed  Google Scholar 

  4. Beetz R (2006) May we go on with antibacterial prophylaxis for urinary tract infections? Pediatr Nephrol 21:5–13

    Article  CAS  PubMed  Google Scholar 

  5. Chesney RW, Carpenter MA, Moxey-Mims M, Nyberg L, Greenfield SP, Hoberman A, Keren R, Matthews R, Matoo TK (2008) Randomized Intervention for Children with Vesicoureteral Reflux (RIVUR): background commentary of RIVUR investigators. Pediatrics 122(Suppl 5):S233–S239

    Article  PubMed  Google Scholar 

  6. Freedman AL (2005) Urologic diseases in North America project: trends in resource utilization for urinary tract infections in children. J Urol 173:949–954

    Article  PubMed  Google Scholar 

  7. World Heatlh Statistics 2009. World Health Organization. http://www.who.int/whois/whostat/2009/ed.index.html. Accessed 6 June 2010

  8. HCUP Kids’ Inpatient Database (KID). Healthcare Cost and Utilization Project (HCUP). 2000, 2003, and 2006. Agency for Healthcare Research and Quality, Rockville, MD. www.hcup-us.ahrq.gov/kidoverview.jsp

  9. HCUP Clinical Classifications Software (CCS) for ICD-10. Healthcare Cost and Utilization Project (HCUP). 2000, 2003, and 2006. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/data/hcup/ccsicd10.htm. Accessed 1 November 2009

  10. Litwin MS, Saigal CS, Yano EM, Avila C, Geschwind SA, Hanley JM, Joyce GF, Madison R, Pace J, Polich SM, Wang M (2005) Urologic diseases in America project: analytical methods and principal findings. J Urol 173:933–937

    Article  PubMed  Google Scholar 

  11. Uhari M, Nuutinen M (1988) Epidemiology of symptomatic infections of the urinary tract in children. BMJ 297:450–452

    Article  CAS  PubMed  Google Scholar 

  12. Winberg J, Andersen HJ, Bergstrom T, Jacobsson B, Larson H, Lincoln K (1974) Epidemiology of symptomatic urinary tract infection in childhood. Acta Paediatr Scand Suppl:1–20

    Article  Google Scholar 

  13. Shaw KN, Gorelick M, McGowan KL, Yakscoe NM, Schwartz JS (1998) Prevalence of urinary tract infection in febrile young children in the emergency department. Pediatrics 102:e16

    Article  CAS  PubMed  Google Scholar 

  14. Jakobsson B, Esbjorner E, Hansson S (1999) Minimum incidence and diagnostic rate of first urinary tract infection. Pediatrics 104:222–226

    Article  CAS  PubMed  Google Scholar 

  15. Shaikh N, Morone NE, Bost JE, Farrell MH (2008) Prevalence of urinary tract infection in childhood: a meta-analysis. Pediatr Infect Dis J 27:302–308

    Article  PubMed  Google Scholar 

  16. American Academy of Pediatrics (1999) Circumcision policy statement. American Academy of Pediatrics. Task force on circumcision. Pediatrics 103:686–693

    Article  Google Scholar 

  17. Schoen EJ, Colby CJ, Ray GT (2000) Newborn circumcision decreases incidence and costs of urinary tract infections during the first year of life. Pediatrics 105:789–793

    Article  CAS  PubMed  Google Scholar 

  18. Millman M (ed) (1993) Access to health care in America. Committee on monitoring access to personal health care services. National Academy Press, Washington, DC

    Google Scholar 

  19. De Marco G, Mangani S, Correra A, Di Caro S, Tarallo L, De Franciscis A, Jefferson T, Guarino A (2005) Reduction of inappropriate hospital admissions of children with influenza-like illness through the implementation of specific guidelines: a case-controlled study. Pediatrics 116:e506–e511

    Article  PubMed  Google Scholar 

  20. Kemper KJ (1988) Medically inappropriate hospital use in a pediatric population. N Engl J Med 318:1033–1037

    Article  CAS  PubMed  Google Scholar 

  21. Cunningham PJ, Clancy CM, Cohen JW, Wilets M (1995) The use of hospital emergency departments for nonurgent health problems: a national perspective. Med Care Res Rev 52:453–474

    Article  CAS  PubMed  Google Scholar 

  22. DeVoe JE, Tillotson CJ, Wallace LS (2009) Children's receipt of health care services and family health insurance patterns. Ann Fam Med 7:406–413

    Article  PubMed  Google Scholar 

  23. Orszag PR, Ellis P (2007) The challenge of rising health care costs—a view from the Congressional Budget Office. N Engl J Med 357:1793–1795

    Article  CAS  PubMed  Google Scholar 

  24. Centers for Medicare and Medicaid Services: 2002 data compendium

  25. Quigley R (2009) Diagnosis of urinary tract infections in children. Curr Opin Pediatr 21:194–198

    Article  PubMed  Google Scholar 

  26. Condra CS, Parbhu B, Lorenz D, Herr SM (2010) Charges and complications associated with the medical evaluation of febrile young infants. Pediatr Emerg Care 26:186–191

    Article  PubMed  Google Scholar 

  27. Dore-Bergeron MJ, Gauthier M, Chevalier I, McManus B, Tapiero B, Lebrun S (2009) Urinary tract infections in 1- to 3-month-old infants: ambulatory treatment with intravenous antibiotics. Pediatrics 124:16–22

    Article  PubMed  Google Scholar 

  28. Gauthier M, Chevalier I, Sterescu A, Bergeron S, Brunet S, Taddeo D (2004) Treatment of urinary tract infections among febrile young children with daily intravenous antibiotic therapy at a day treatment center. Pediatrics 114:e469–e476

    Article  PubMed  Google Scholar 

  29. Pena DA, Viviani ST, Le Corre PN, Morales MV, Montecinos BC, Gajardo SC (2009) Treatment of urinary tract infections in febrile infants: experience of outpatient intravenous antibiotic treatment. Rev Chilena Infectol 26:350–354

    Google Scholar 

  30. Baskin MN, O'Rourke EJ, Fleisher GR (1992) Outpatient treatment of febrile infants 28 to 89 days of age with intramuscular administration of ceftriaxone. J Pediatr 120:22–27

    Article  CAS  PubMed  Google Scholar 

  31. Hoberman A, Wald ER, Hickey RW, Baskin M, Charron M, Majd M, Kearney DH, Reynolds EA, Ruley J, Janosky JE (1999) Oral versus initial intravenous therapy for urinary tract infections in young febrile children. Pediatrics 104:79–86

    Article  CAS  PubMed  Google Scholar 

  32. Montini G (2008) Antibiotic treatment of pyelonephritis in children. Recent advances. Recenti Prog Med 99:343–346

    PubMed  Google Scholar 

  33. Neuhaus TJ, Berger C, Buechner K, Parvex P, Bischoff G, Goetschel P, Husarik D, Willi U, Molinari L, Rudin C, Gervaix A, Hunziker U, Stocker S, Girardin E, Nadal D (2008) Randomised trial of oral versus sequential intravenous/oral cephalosporins in children with pyelonephritis. Eur J Pediatr 167:1037–1047

    Article  CAS  PubMed  Google Scholar 

  34. Keren R, Chan E (2002) A meta-analysis of randomized, controlled trials comparing short- and long-course antibiotic therapy for urinary tract infections in children. Pediatrics 109:E70-0

    Article  PubMed  Google Scholar 

  35. Michael M, Hodson EM, Craig JC, Martin S, Moyer VA (2003) Short versus standard duration oral antibiotic therapy for acute urinary tract infection in children. Cochrane Database Syst Rev CD003966

  36. Tran D, Muchant DG, Aronoff SC (2001) Short-course versus conventional length antimicrobial therapy for uncomplicated lower urinary tract infections in children: a meta-analysis of 1279 patients. J Pediatr 139:93–99

    Article  CAS  PubMed  Google Scholar 

  37. Shapiro ED (1982) Short course antimicrobial treatment of urinary tract infections in children: a critical analysis. Pediatr Infect Dis 1:294–297

    Article  CAS  PubMed  Google Scholar 

  38. American Academy of Pediatrics (1999) Practice parameter: the diagnosis, treatment, and evaluation of the initial urinary tract infection in febrile infants and young children. American Academy of Pediatrics. Committee on quality improvement. Subcommittee on urinary tract infection. Pediatrics 103:843–852

    Google Scholar 

  39. Avner ED, Ingelfinger JR, Herrin JT, Link DA, Marcus E, Tolkoff-Rubin NE, Russell-Getz L, Rubin RH (1983) Single-dose amoxicillin therapy of uncomplicated pediatric urinary tract infections. J Pediatr 102:623–627

    Article  CAS  PubMed  Google Scholar 

  40. Gaudreault P, Beland M, Girodias JB, Thivierge RL (1992) Single daily doses of trimethoprim/sulphadiazine for three or 10 days in urinary tract infections. Acta Paediatr 81:695–697

    Article  CAS  PubMed  Google Scholar 

  41. Petersen KE (1991) Short-term treatment of acute urinary tract infections in girls. Scand J Infect Dis 23:213–220

    Article  Google Scholar 

  42. Downs SM (1999) Technical report: urinary tract infections in febrile infants and young children. The urinary tract subcommittee of the American Academy of Pediatrics committee on quality improvement. Pediatrics 103:e54

    Article  CAS  PubMed  Google Scholar 

  43. Garin EH, Olavarria F, Garcia Nieto V, Valenciano B, Campos A, Young L (2006) Clinical significance of primary vesicoureteral reflux and urinary antibiotic prophylaxis after acute pyelonephritis: a multicenter, randomized, controlled study. Pediatrics 117:626–632

    Article  PubMed  Google Scholar 

  44. Montini G, Rigon L, Zucchetta P, Fregonese F, Toffolo A, Gobber D, Cecchin D, Pavanello L, Molinari PP, Maschio F, Zanchetta S, Cassar W, Casadio L, Crivellaro C, Fortunati P, Corsini A, Calderan A, Comacchio S, Tommasi L, Hewitt IK, Da Dalt L, Zacchello G, Dall'Amico R (2008) Prophylaxis after first febrile urinary tract infection in children? A multicenter, randomized, controlled, noninferiority trial. Pediatrics 122:1064–1071

    Article  PubMed  Google Scholar 

  45. Pennesi M, Travan L, Peratoner L, Bordugo A, Cattaneo A, Ronfani L, Minisini S, Ventura A (2008) Is antibiotic prophylaxis in children with vesicoureteral reflux effective in preventing pyelonephritis and renal scars? A randomized, controlled trial. Pediatrics 121:e1489–e1494

    Article  PubMed  Google Scholar 

  46. Roussey-Kesler G, Gadjos V, Idres N, Horen B, Ichay L, Leclair MD, Raymond F, Grellier A, Hazart I, de Parscau L, Salomon R, Champion G, Leroy V, Guigonis V, Siret D, Palcoux JB, Taque S, Lemoigne A, Nguyen JM, Guyot C (2008) Antibiotic prophylaxis for the prevention of recurrent urinary tract infection in children with low grade vesicoureteral reflux: results from a prospective randomized study. J Urol 179:674–679; discussion 679

    Article  CAS  PubMed  Google Scholar 

  47. Brandstrom P, Esbjorner E, Herthelius M, Swerkersson S, Jodal U, Hansson S (2010) The Swedish reflux trial in children: III. Urinary tract infection pattern. J Urol 184:286–291

    Article  PubMed  Google Scholar 

  48. Craig JC, Simpson JM, Williams GJ, Lowe A, Reynolds GJ, McTaggart SJ, Hodson EM, Carapetis JR, Cranswick NE, Smith G, Irwig LM, Caldwell PH, Hamilton S, Roy LP (2009) Antibiotic prophylaxis and recurrent urinary tract infection in children. N Engl J Med 361:1748–1759

    Article  CAS  PubMed  Google Scholar 

  49. Montini G, Hewitt I (2009) Urinary tract infections: to prophylaxis or not to prophylaxis? Pediatr Nephrol 24:1605–1609

    Article  PubMed  Google Scholar 

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Correspondence to David S. Hains.

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Spencer, J.D., Schwaderer, A., McHugh, K. et al. Pediatric urinary tract infections: an analysis of hospitalizations, charges, and costs in the USA. Pediatr Nephrol 25, 2469–2475 (2010). https://doi.org/10.1007/s00467-010-1625-8

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