September 22, 2022

Antibiotic management increases the use of guideline-compliant antibiotics for UTIs

According to the results of a study published in Clinical infectious diseases.

This quasi-experimental prospective study was conducted in 1 community hospital and 2 university hospitals in North Carolina. A multidisciplinary team of clinicians designed an ED-specific guideline for the appropriate use of antibiotics for patients with UTIs admitted to the ED. Resident clinicians attended training sessions and received feedback on guideline concordance. Patients (N=8742) diagnosed with acute cystitis or pyelonephritis between 2018 and 2021 were assessed for antibiotic use according to guidelines. The study included a baseline period (zero phase) followed by 2 intervention phases. Phase 1 involved implementation of ED-specific urine susceptibility testing and UTI treatment guidelines, education and feedback on UTI diagnoses and antibiotic treatment, and Phase 2 involved re-education and feedback from clinicians. The primary outcome of compliant antibiotic use was assessed by interrupted time series regression analysis with 2-week intervals.

Among patients admitted to the ER in phases zero (n=5023), 1 (n=3454) and 2 (n=1949) of the study, the mean ages were 47.6, 47.9 and 49.2 years ; 77.8%, 75.5% and 73.6% were women; 55.1%, 53.2% and 50.8% were black; and 93.1%, 90.6% and 91.1% were diagnosed with cystitis, respectively.


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The overall rate of compliant antibiotic prescriptions increased from 42.8% during phase zero to 49.7% and 56.1% during phases 1 and 2, respectively. The greatest increase in the rate of use of antibiotics in accordance with recommendations was observed during phase 2 among patients admitted to the emergency department of a community hospital (64.1%).

Compared to phase zero, recommendations-compliant antibiotic prescriptions increased by 15% in phase 1 (incidence rate ratio [IRR], 1.15; 95% CI, 1.03-1.29; P =.02). In phase 2, prescriptions of antibiotics in accordance with recommendations increased by 3% for each 2-week interval (IRR, 1.03; 95% CI, 1.01-1.04; P <.01>

With respect to the overall rate of UI diagnoses, no significant changes were observed throughout the duration of the study (P ³.37). Analyzes of individual emergency departments showed a significant increase in rates of UI diagnoses in the 2 community hospitals compared to the teaching hospital (both P <.01>

This study may have been limited by the use of diagnosis codes rather than patient symptoms to diagnose UTIs.

This study found that a multifaceted antibiotic management program including training and performance feedback increased guideline-compliant antibiotic use in patients with UTIs admitted to an emergency department. “Future studies are warranted to examine other potential strategies for [decrease] inappropriate UTI diagnosis,” the researchers concluded.

Disclosure: Several authors have declared industry affiliations. Please see the original reference for a full list of disclosures.

Reference

Nys CL, Fischer K, Funaro J, et al. Impact of education and data feedback on antibiotic prescribing for urinary tract infections in the emergency department: an interrupted time series analysis. Blink Infect Dis. 2022; ciac073. doi:10.1093/cid/ciac073