1. Nationwide epidemiology and clinical practice patterns of pediatric urinary tract infections: application of multivariate time-series clustering.
- Author
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Okubo, Yusuke, Uda, Kazuhiro, Miyairi, Isao, Michihata, Nobuaki, Kumazawa, Ryosuke, Matsui, Hiroki, Fushimi, Kiyohide, and Yasunaga, Hideo
- Subjects
SCIENTIFIC observation ,URINARY tract infections ,MACHINE learning ,RETROSPECTIVE studies ,ACQUISITION of data ,TIME series analysis ,MEDICAL records ,RESEARCH funding ,PHYSICIAN practice patterns ,ALGORITHMS ,ANTIBIOTICS ,CHILDREN - Abstract
Background : The nationwide epidemiology and clinical practice patterns for younger children hospitalized with urinary tract infections (UTIs) were unclear. Methods: We conducted a retrospective observational study consisting of 32,653 children aged < 36 months who were hospitalized with UTIs from 856 medical facilities during fiscal years 2011–2018 using a nationally representative inpatient database in Japan. We investigated the epidemiology of UTIs and changes in clinical practice patterns (e.g., antibiotic use) over 8 years. A machine learning algorithm of multivariate time-series clustering with dynamic time warping was used to classify the hospitals based on antibiotic use for UTIs. Results: We observed marked male predominance among children aged < 6 months, slight female predominance among children aged > 12 months, and summer seasonality among children hospitalized with UTIs. Most physicians selected intravenous second- or third-generation cephalosporins as the empiric therapy for treating UTIs, which was switched to oral antibiotics during hospitalizations for 80% of inpatients. Whereas total antibiotic use was constant over the 8 years, broad-spectrum antibiotic use decreased gradually from 5.4 in 2011 to 2.5 days of therapy per 100 patient-days in 2018. The time-series clustering distinctively classified 5 clusters of hospitals based on antibiotic use patterns and identified hospital clusters that preferred to use broad-spectrum antibiotics (e.g., antipseudomonal penicillin and carbapenem). Conclusions: Our study provided novel insight into the epidemiology and practice patterns for pediatric UTIs. Time-series clustering can be useful to identify the hospitals with aberrant practice patterns to further promote antimicrobial stewardship. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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