CP-004 A review of urinary tract infection management for patients admitted to the emergency department: assessment of adherence to guidelines and identification of hospitalisation criteria

Background Community acquired urinary tract infection (UTI) is one of the most common indications for antibiotic prescription. Previous studies on adherence to guidelines on antibiotic use reported a prevalence of inappropriate prescriptions varying from 20% to 50%, in both community and hospital settings. The misuse of antibiotics not only has an important economic impact but can also lead to therapeutic impasses. Purpose This study aimed to establish the current management of UTIs in patients admitted to the emergency department (ED) of our hospital. Material and methods In this retrospective observational study conducted between January 2015 and May 2016, consecutive patients admitted to the ED for a suspected UTI were assessed, including patients hospitalised (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 hospitalised 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 patient 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 also identified discrepancies between reasons for hospitalisation in our cohort compared with the criteria for hospitalisation mentioned in the national guidelines. Conclusion This study has identified areas for improvement in the management of UTIs in our hospital. Our suggestions for optimisation include educational materials and a decision tree displayed in the ED, and specific therapeutic protocols in our computerised prescription system. References and/or acknowledgements SPILF Guidelines2015: http://www.infectiologie.com/fr/recommandations.html No conflict of interest