Assessing Adherence to Evidence-Based Guidelines for the Diagnosis and Management of Uncomplicated Urinary Tract Infection

Grover, Michael; Bracamonte, Jesse D.; Kanodia, Anup K.; Bryan, Michael; Donahue, Sean P.; Warner, Anne-Marie; Edwards, Frederick D.; Weaver, Amy L.

doi:10.1016/s0025-6196(11)60996-8

Cited by 35 publications

(14 citation statements)

References 10 publications

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“…The ED is a frequent site of antibiotic use and thus, provides a unique opportunity for antimicrobial stewardship. Up to half of all antimicrobial prescriptions are inappropriate [3], with poor adherence with evidence based guidelines (EBG) for infectious diseases [4, 5] and overuse of broad spectrum antibiotics [6, 7]; however, this has not been quantified in an ED setting.…”

Section: Introductionmentioning

confidence: 99%

A single center observational study on emergency department clinician non-adherence to clinical practice guidelines for treatment of uncomplicated urinary tract infections

et al. 2016

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BackgroundThe Emergency Department (ED) is a frequent site of antibiotic use; poor adherence with evidence-based guidelines and broad-spectrum antibiotic overuse is common. Our objective was to determine rates and predictors of inappropriate antimicrobial use in patients with uncomplicated urinary tract infections (UTI) compared to the 2010 International Clinical Practice Guidelines (ICPG).MethodsA single center, prospective, observational study of patients with uncomplicated UTI presenting to an urban ED between September 2012 and February 2014 that examined ED physician adherence to ICPG when treating uncomplicated UTIs. Clinician-directed antibiotic treatment was compared to the ICPG using a standardized case definition for non-adherence. Binomial confidence intervals and student’s t-tests were performed to evaluate differences in demographic characteristics and management between patients with pyelonephritis versus cystitis. Regression models were used to analyze the significance of various predictors to non-adherent treatment.Results103 cases met the inclusion and exclusion criteria, with 63.1 % receiving non-adherent treatment, most commonly use of a fluoroquinolone (FQ) in cases with cystitis (97.6 %). In cases with pyelonephritis, inappropriate antibiotic choice (39.1 %) and no initial IV antibiotic for pyelonephritis (39.1 %) where recommended were the most common characterizations of non-adherence. Overall, cases of cystitis were no more/less likely to receive non-adherent treatment than cases of pyelonephritis (OR 0.9, 95 % confidence interval 0.4–2.2, P = 0.90). In multivariable analysis, patients more likely to receive non-adherent treatment included those without a recent history of a UTI (OR 3.8, 95 % CI 1.3–11.4, P = 0.02) and cystitis cases with back or abdominal pain only (OR 11.4, 95 % CI 2.1–63.0, P = 0.01).ConclusionsPatients with cystitis with back or abdominal pain only were most likely to receive non-adherent treatment, potentially suggesting diagnostic inaccuracy. Physician education on evidence-based guidelines regarding the treatment of uncomplicated UTI will decrease broad-spectrum use and drug resistance in uropathogens.

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Section: Introductionmentioning

confidence: 99%

A single center observational study on emergency department clinician non-adherence to clinical practice guidelines for treatment of uncomplicated urinary tract infections

et al. 2016

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“…In fact, midurethral slings have recently been shown to be highly effective up to 11.5 years. Urinary tract infection is also associated with catheter usage, particularly in the postoperative period 18,19 Urinary tract infection accounts for approximately 8.3 million office visits per year, 20 and physician compliance to guidelines for the treatment of UTI is poor. 3Y15 Reported complications include bleeding (2.7%Y8.6%.…”

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confidence: 99%

“…2 In recent years, there have been numerous studies reporting complications associated with midurethral slings. 20 Anger et al 3 noted in their article that although there was extensive literature on the success of sling placement regarding improved quality of life for the patient, there was a substantial lack of research regarding the prevention of specific postoperative complications, such as UTI. ), bladder injury (5%Y10%), urethral injury (0.3%Y1.4%), 2 and vaginal mesh erosion (0.6%Y1%).…”

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confidence: 99%

Antibiotic Prophylaxis for Urinary Tract Infection After Midurethral Sling

Jackson¹,

Higgins²,

Bracken³

et al. 2013

Female Pelvic Medicine &Amp; Reconstructive Surgery

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“…The year 2016, when the new recommendations were implemented, was characterized by the strong increase in the delivery of pivmecillinam, which officially entered the therapeutic arsenal, and the significant decrease of ciprofloxacin. However, as the physicians’ adherence to recommendations is poor, policymakers should combine the publication of new guidelines with interventions to convince prescribers [ 24 , 33 – 37 ]. For example, in England, to reduce inappropriate UTI management, and to limit the risk of trimethoprim resistance, the National Health Service introduced the ‘Quality Premium’ program in 2016 with the aim of reducing trimethoprim prescriptions through financial incentives [ 38 ].…”

Section: Discussionmentioning

confidence: 99%

Changes in the management of urinary tract infections in women: impact of the new recommendations on antibiotic prescribing behavior in France, between 2014 and 2019

Piraux

Faure

Naber

et al. 2021

BMC Health Serv Res

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Background Urinary tract infections (UTIs) are among the most common infections that require antibiotic therapy. In December 2015, new guidelines for UTI management were published in France with the aim of reducing antibiotic misuse and the risk of antimicrobial resistance. Objectives To analyze changes in antibiotic prescribing behavior for acute uncomplicated UTI in women in France from 2014 to 2019. Methods Retrospective study using data extracted from the medico-administrative database ‘OpenMedic’ that is linked to the French National Health Data System and collects data on the reimbursement of prescribed drugs. The analyses focused on the number of boxes of antibiotics delivered by community pharmacies, the molecule class, and the prescriber’s specialty. Results Overall, antibiotic dispensing by community pharmacies increased by 2% between 2014 and 2019, but with differences in function of the antibiotic class. The use of antibiotics recommended as first-line and second-line treatment increased (+ 41% for fosfomycin and + 7430% for pivmecillinam). Conversely, the dispensing of lomefloxacin and norfloxacin decreased by 80%, and that of ciprofloxacin by 26%. Some antibiotics were mostly prescribed by general practitioners (lomefloxacin, pivmecillinam) and others by secondary care physicians (ofloxacin). Dispensing increased for antibiotics prescribed by secondary care physicians (+ 13% between 2014 and 2019) and decreased for antibiotics prescribed by GPs (− 2% for the same period). Conclusion These data suggest that the new recommendations are followed, as indicated by the increased prescription of fosfomycin and pivmecillinam and decreased prescription of fluoroquinolones. However, the efficient transmission and implementation of new recommendations by practitioners requires time, means and dedicated tools.

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Assessing Adherence to Evidence-Based Guidelines for the Diagnosis and Management of Uncomplicated Urinary Tract Infection

Cited by 35 publications

References 10 publications

A single center observational study on emergency department clinician non-adherence to clinical practice guidelines for treatment of uncomplicated urinary tract infections

A single center observational study on emergency department clinician non-adherence to clinical practice guidelines for treatment of uncomplicated urinary tract infections

Antibiotic Prophylaxis for Urinary Tract Infection After Midurethral Sling

Changes in the management of urinary tract infections in women: impact of the new recommendations on antibiotic prescribing behavior in France, between 2014 and 2019

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