4CPS-063 Appropriateness of antibiotic prescribing in urinary tract infections in the emergency department of a tertiary hospital

Background It is considered that 30% to 50% of antibiotic prescriptions in the Emergency Department (ED) are inappropriate. Urinary tract infections (UTI) are one of the most commonly diagnosed infections in the ED. Purpose To assess the appropriateness of antibiotic prescriptions for UTI in the ED of a tertiary hospital. Material and methods Observational, retrospective study which included patients who attended the ED, during November 2016, with an antibiotic prescription and an UTI discharge diagnosis. To assess the appropriateness of antibiotic prescriptions, they were compared to local empirical antibiotic treatment guidelines. Data were collected from the medical records of patients. Results One hundred and eighty-four antibiotic prescriptions for UTI were included, representing 27.2% (676) of all antibiotics prescribed during the period of study. One hundred and thirty-eight females (75%), mean age 45.8±20.3. Patients’ diagnoses were: 61.4% (113) acute or recurrent lower UTI in females, 17.4% (32) UTI in males, 13% (24) pyelonephritis, 5.4% (10) catheter-related infections, 2.2% (four) prostatitis and 0.5% (one) bacteriuria. Prescribed antibiotics were: 32.1% (59) fosfomycin trometamol, 20.7% (38) ciprofloxacin, 14.1% (26) amoxicillin/clavulanate, 6.5% (12) cefixime, 5.8% (10) cefuroxime, 5.4% (10) calcium fosfomycin, 4.9% (nine) norfloxacyn, 4.3% (eight), cefditoren, 2.7% (five) levofloxacin, 2.2% (four) amoxicillin, 1.1% (two) asymptomatic ceftibuten and 0.5% (one) doxycycline. In 90.8% (167) of the prescriptions, the use of an antibiotic drug was indicated. When indicated, an appropriate antibiotic was selected in 61.7% (103/167) of the prescriptions, with an appropriate dosage and duration of antibiotic treatment in 77.7% (80/103) and 68% (70/103) of the prescriptions, respectively. In 16.3% (30) and 39.7% (73) of the analysed episodes, patients required previous or subsequent medical assistance (Emergency Department, ambulatory care and hospitalisation) for UTI, respectively. Conclusion Our results show a low appropriateness of antibiotic prescriptions mainly due to an incorrect selection of the antibiotic, dosage and duration. There is also an overuse of broad spectrum antibiotics: amoxicillin/clavulanate and ciprofloxacin. More than one-third of the patients needed subsequent medical assistance. Adherence to local empirical antibiotic treatment guidelines for UTI treatment should be enhanced, as the basis of a series of strategies to optimise antibiotic prescriptions in this area. No conflict of interest