Assessment and Optimization of the Empiric Treatment of Urinary Tract Infections in an Academic Emergency Department Observation Unit

Patel, Shivali K.; Elshaboury, Ramy H.; Gandhi, Ronak G.; Hayes, Bryan D.; Yun, Brian J.; Koehl, Jennifer L.

doi:10.1016/j.jemermed.2019.12.021

Cited by 2 publications

(2 citation statements)

References 20 publications

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“…The level of guideline adherence declined if the condition was more severe (i.e. cystitis vs. pyelonephritis); however, results were not adjusted for confounders [18].…”

Section: Antibiotic Stewardship In Emergency Departmentsmentioning

confidence: 96%

Rising significance of antibiotic stewardship in urology and urinary tract infections – a rapid review

Schneidewind

Kranz

Tandoğdu

2021

Current Opinion in Urology

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Purpose of review To give an overview of the significance as well as recent developments in antibiotic stewardship (ABS) in urology and for the treatment of urinary tract infections (UTI). This rapid review is focused on recent publications during the past 18 months. Recent findings Despite the evidence to support the use of ABS interventions in the treatment of UTIs, there remains considerable inappropriate use of antibiotics, up to 68%, especially concerning the treatment of asymptomatic bacteriuria and the overuse of fluoroquinolones. Emerging evidence indicate that ABS programs can improve patient outcome and reduce multidrug-resistant pathogens. Interestingly, in this past 18 months new targets for ABS have been developed, e.g. involvement of a pharmacist, strict adherence to guidelines, improvement of the guidelines itself and understanding the prescription process in the emergency room as well as the analysis of own surveillance data. Summary ABS programs in urology are essential and their significance has become more apparent than ever before. New targets for ABS interventions should be evaluated in prospective controlled clinical trials of their effectiveness to reduce further inappropriate antibiotic use without hindering the treatment of UTIs.

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“…The level of guideline adherence declined if the condition was more severe (i.e. cystitis vs. pyelonephritis); however, results were not adjusted for confounders [18].…”

Section: Antibiotic Stewardship In Emergency Departmentsmentioning

confidence: 96%

Rising significance of antibiotic stewardship in urology and urinary tract infections – a rapid review

Schneidewind

Kranz

Tandoğdu

2021

Current Opinion in Urology

View full text Add to dashboard Cite

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“…Emergency Department Observation Units (EDOUs) are strategic areas where patients receive prompt treatment and are expected to be discharged or admitted to the hospital within a short period of time. There, the diagnosis of infections is very common, and the prescription of antimicrobial agents has a substantial impact on both inpatient and outpatient care [5,6]. Recent guidelines recognize the implementation of ASPs in Emergency Departments (EDs) as a priority [7].…”

Section: Introductionmentioning

confidence: 99%

Antimicrobial Stewardship in the Emergency Department Observation Unit: Definition of a New Indicator and Evaluation of Antimicrobial Use and Clinical Outcomes

Guisado-Gil,

Mejías-Trueba,

Peñalva

et al. 2024

Antibiotics

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We aimed to define a novel indicator for monitoring antimicrobial use specifically in the Emergency Department Observation Unit (EDOU) and to assess the long-term impact of an institutional education-based antimicrobial stewardship program (ASP) on the antimicrobial prescribing pattern and clinical outcomes in this setting. A quasi-experimental interrupted time-series study was performed from 2011 to 2022. An educational ASP was implemented at the EDOU in 2015. To estimate changes in antimicrobial use, we designed an indicator adjusted for patients at risk of antimicrobial prescribing: defined daily doses (DDDs) per 100 patients transferred from the Emergency Department to the Observation Unit (TOs) per quarter. The number of bloodstream infections (BSIs) and the crude all-cause 14-day mortality were assessed as clinical outcomes. Antimicrobial use showed a sustained reduction with a trend change of −1.17 DDD per 100 TO and a relative effect of −45.6% (CI95% −64.5 to −26.7), particularly relevant for meropenem and piperacillin-tazobactam, with relative effects of −80.4% (−115.0 to −45.7) and −67.9% (−93.9 to −41.9), respectively. The incidence density of all BSIs increased significantly during the ASP period, with a relative effect of 123.2% (41.3 to 284.7). The mortality rate remained low and stable throughout the study period, with an absolute effect of −0.7% (−16.0 to 14.7). The regular monitoring of antimicrobial use in the EDOU by using this new quantitative indicator was useful to demonstrate that an institutional education-based ASP successfully achieved a long-term reduction in overall antimicrobial use, with a low and steady BSI mortality rate.

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Assessment and Optimization of the Empiric Treatment of Urinary Tract Infections in an Academic Emergency Department Observation Unit

Cited by 2 publications

References 20 publications

Rising significance of antibiotic stewardship in urology and urinary tract infections – a rapid review

Rising significance of antibiotic stewardship in urology and urinary tract infections – a rapid review

Antimicrobial Stewardship in the Emergency Department Observation Unit: Definition of a New Indicator and Evaluation of Antimicrobial Use and Clinical Outcomes

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