A review of urinary tract infection management for patients admitted to the emergency department: Assessment of adherence to guidelines and identification of hospitalization criteria

Background & objectives Community-acquired urinary tract infections (UTIs) are the second most common indication for antibiotic prescription in France. Previous studies on the adherence to guideline on antibiotic use reported a prevalence of inappropriate prescriptions varying from 20 to 50%, both in the community and hospital settings. The misuse of antibiotics not only have an important economic impact but can also lead to therapeutic impasses. This study aimed at establishing the current management of UTIs for patients admitted to the emergency department (ED) of our hospital. Methods This retrospective observational study was conducted in the European Hospital of Marseille January 2015 and May 2016. Consecutive patients admitted to the ED for a suspected UTI were included, including patients hospitalized ( n  = 50) or discharged ( n  = 50) after their ED admission. Assessment of adherence to guidelines for antibiotic prescription was conducted using the guidelines of the French-speaking society of infectious disease (SPILF). Results In the hospitalized group, 22 (44%) antibiotic prescriptions initiated at the ED did not comply with national guidelines. The two main causes for inappropriate prescriptions were the use of two antibiotics in patients with no severity criteria (15, 68%) and/or the use of a non-recommended drug (6, 27%). In this group, 17 (35%) antibiotic prescriptions ordered by the urologist on patients’ discharge did not comply with national guidelines. The two main causes of inappropriate prescriptions were the use of a non-recommended drug (9, 53%) and an inadequate duration of treatment (9, 53%). In the discharged group, 29 (60%) of the antibiotic prescriptions ordered at the ED did not comply with national guidelines. The two main causes of inappropriate prescriptions were an inadequate duration of treatment (23, 79%) and the use of a non-recommended drug (19, 66%). We could also identify discrepancies between reasons for hospitalization in our cohort compared to the criteria for hospitalization mentioned in the national guidelines. Discussion & conclusions This study has identified areas of improvement for the management of UTIs in our hospital. Our suggestions for optimization include educational materials and a decision tree displayed at the ED and specific therapeutic protocols in our computerized prescription system.