Unnecessary antibiotic prescriptions common in ED-diagnosed UTI
Many patients prescribed antibiotics for suspected urinary tract infection (UTI) in the emergency department (ED) may not actually require them, according to a single-centre study from the UK presented at ECCMID 2019.
“Sixty to 70 percent of patients who were diagnosed with lower UTI or pyelonephritis in the ED lacked clinical or microbiological evidence of this condition, but antibiotics were stopped early in less than one quarter of patients with an ED diagnosis of UTI syndromes,” said the authors led by Dr Laura Shallcross from University College London, London, UK.
Researchers assessed data of 943 patients who presented with suspected UTI at the ED of the Queen Elizabeth Hospital in Birmingham, UK, of whom 71 percent (n=671) were admitted to hospital. A total of 289 patients were diagnosed with UTI syndromes in the ED, a majority of which were lower UTI (n=191), followed by pyelonephritis (n=56) and urosepsis (n=42).
Ninety-one percent of patients (n=173) diagnosed with lower UTI in the ED were prescribed empirical antibiotics. However, 70 percent of patients admitted and 59.2 percent of those not admitted (n=49 and 61, respectively) did not have clinical or microbiological evidence of UTI. [ECCMID 2019, abstract 2133]
While almost all patients diagnosed with pyelonephritis in the ED received antibiotics, 61.1 percent (n=33) did not have clinical or microbiological evidence of the condition, while only 26.1 percent of cases of ED-diagnosed urosepsis (n=11) had clinical or microbiological evidence of the condition.
Among patients who were admitted to the hospital due to a diagnosis of UTI in the ED, diagnosis codes showed that UTI was the main reason for admission in less than 40 percent of the patients. Specifically, of 83 patients who were admitted to hospital due to ED-diagnosed lower UTI, more than 40 percent (n=34) had a primary diagnosis for a non-infectious condition and had received antibiotic treatment for a median 7.5 days.
About 15 percent of patients with ED-diagnosed UTI (n=25) had their antibiotics stopped at admission, while 23.3 percent (n=37) had their antibiotics stopped within 72 hours of admission.
“Concern over delaying antibiotic treatment for severe infection means that clinicians have a low threshold for initiating antibiotics in the ED for patients with suspected UTI syndromes,” said Shallcross and co-authors. In addition, continuing unnecessary antibiotic therapy contributes to antimicrobial resistance, they added.
The high number of unnecessary antibiotic prescriptions coupled with the slow termination of the regimen highlights the “scope to further reduce antibiotic prescribing for this common condition”, they said.
“A focus on antibiotic review in patients with an ED diagnosis of suspected UTIs could support reductions in inappropriate antibiotic prescribing in secondary care and help reduce the impact of unnecessary prescribing on the development of antibiotic resistance,” they said.