ECCMID19: Patients treated for suspected UTIs often lack evidence of infection

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Only one-third of patients entering the emergency department (ED) with a suspected urinary tract infection (UTI) actually have evidence of infection, however, almost all were treated with antibiotics, according to research presented at the European Congress of Clinical Microbiology and Infectious Diseases (ECCMID; 13–16 April, Amsterdam, the Netherlands).

The study, from University College London (UK), estimated the frequency of over-diagnosis of UTI symptoms in the ED in order to estimate the potential to reduce inappropriate antibiotic prescribing.

The team carried out a cohort study at the Queen Elizabeth Hospital (Birmingham, UK), using electronic health records from patients with suspected UTI syndromes who attended the ED. Individuals with a sample submitted for culture were eligible for inclusion, and the team took a subset of 1000 patients, comparing diagnoses made by the ED physician to the diagnosis based on clinical symptoms, microbiological outcomes and ICD-10. They also estimated how often antibiotics were stopped at, or shortly after, hospital admission.

From a total of 943 eligible patients, 289 patients had an ED diagnosis of UTI syndromes, including urosepsis, pyelonephritis and lower UTI. Treatment with empirical antibiotics was recorded for 91% (173) of patients with an ED diagnosis of lower UTI, however, only 36.4% of these cases had clinical evidence. ICD-10 codes were available for 83 patients with lower UTI who were admitted to hospital, and of these patients over 40% had a code designating a non-infectious condition, suggesting that antibiotics were not required.

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