Impact of antibiotic choices made in the emergency department on appropriateness of antibiotic treatment of urinary tract infections in hospitalized patients

Abstract

BACKGROUND Overuse of antibiotics to treat urinary tract infections (UTIs) is common in hospitalized patients and may begin in the emergency department (ED). METHODS For a 4‐week period we reviewed medical records of all patients admitted to the hospital who initiated treatment for a UTI in the ED. RESULTS According to study criteria, initiation of antibiotics was inappropriate for 55 of 94 patients (59% [95% confidence interval {CI}, 48%‐69%]), and continuation after admission was inappropriate for 54 of 80 patients (68% [95% CI, 57%‐78%]). CONCLUSION Failure to reevaluate the need for antibiotics initiated in the ED to treat UTIs may lead to overuse of antibiotics in hospitalized patients. Journal of Hospital Medicine 2016;11:181–184. © 2015 Society of Hospital Medicine

Antimicrobial prescription in patients dying from chronic obstructive pulmonary disease

“…Kiyatkin et al showed that, in patients treated for a urinary tract infection in the ED, over half were treated with inappropriate antimicrobials, the majority of which were continued into the admission. 30 We hypothesise that a similar effect may occur in treating COPD exacerbations: antimicrobials are frequently initiated by junior medical staff in the ED who may not have a full understanding of current guidelines. Lack of awareness and familiarity with clinical practice guidelines have been repeatedly shown to be the principal barrier to guideline adherence.…”

Urine Culture on Admission Impacts Antibiotic Use and Length of Stay: A Retrospective Cohort Study

“…This finding supports a recent singlecenter study that demonstrated that antibiotics started by emergency room providers are often continued in the inpatient setting even when tests return negative. 8 The second notable finding is that the impact of urine culture testing on antibiotic use varied by diagnosis group. Urine cultures had the greatest impact on antibiotic ordering for diagnoses where antibiotic use was uncommon and, presumably, where routine urine culture testing would not be indicated as part of the hospital workup, such as cardiac arrhythmias and chest pain.…”

“…9,10 Prior literature has routinely demonstrated that hospitalized patients are often inappropriately started and continued on antibiotics in response to false-positive urine cultures. [7][8][9][10] Unnecessary antibiotics have risks, not only for the patients receiving the antibiotics but also for other patients cared for in the same hospital. One recent study demonstrated that receipt of antibiotics by prior hospital bed occupants was an independent risk factor for Clostridium difficile infection in subsequent patients occupying the same bed, regardless of whether the initial occupant had Clostridium difficile.…”

“…6,7 Positive urine cultures, even in the absence of symptoms, are strongly linked to subsequent inappropriate antibiotic use in hospitalized patients. [7][8][9][10] Inappropriate antibiotic use contributes to antibiotic resistance and is a threat to public health. [11][12][13] For these reasons, the Choosing Wisely campaign and several national guidelines strongly recommend against urine culture testing in the absence of urinary tract symptoms.…”

“…Prior studies examining the effect of inpatient urine culture testing on antibiotic use have been limited to small samples drawn from a few institutions. [6][7][8][9][10] The aims of this study were to examine the impact of inpatient urine culture testing on inpatient antibiotic use and hospital LOS using a national administrative dataset. To guide development of interventions aimed at reducing unnecessary urine testing, we identified the inpatient medical and surgical diagnoses most impacted by urine culture testing on admission.…”