Incidence and Management of Urinary Tract Infection in a National Medicaid Population, 2009-2019

BACKGROUND AND OBJECTIVE Recent investigations and the most recent American Academy of Pediatrics guidelines have advocated for stricter criteria for urinary tract infection (UTI) diagnosis and a more selective approach to voiding cystourethrograms (VCUGs). We aimed to determine recent temporal trends in UTI diagnoses, downstream interventions, and recurrent UTI in young children with Medicaid. METHODS We identified children younger than age 2 years with UTI enrolled in the United States’ Medicaid MarketScan Database from 2009–2019. We evaluated trends in first UTIs (index or iUTI), downstream interventions including renal/bladder ultrasonography (RBUS), VCUG, continuous antibiotic prophylactic (CAP), and urology referral and recurrent UTIs. Changes in rates and proportions over time were assessed using Poisson and logistic regression models, respectively. RESULTS Of 4 296 966 children, 48.8% were female. The incidence of iUTI was 0.89 per 1000 patient months (95% CI, 0.89–0.90) and decreased over time (incidence rate ratio [IRR], 0.93 per year; 95% CI, 0.92–0.93). RBUS was obtained in 37.3% of children with iUTI with no change over time. Use of VCUG (odds ratio [OR], 0.87; 95% CI, 0.86–0.88) and CAP (OR, 0.95; 95% CI, 0.94–0.96) decreased during the study period, while urology clinic visits increased (OR, 1.06; CI, 1.05–1.08). Overall population rate of recurrent UTI decreased (IRR, 0.95; 95% CI, 0.94–0.95). CONCLUSIONS In children <2 years, the incidence of UTI, use of VCUG and CAP decreased over time without an apparent rise in recurrent UTI. These findings suggest improving health care value for UTI management. Further studies are needed to determine effects on long term outcomes, such as chronic kidney disease.