Appropriateness of antibiotic prescribing for urinary tract infection in the emergency department of a tertiary care hospital

Abstract

Background: Urinary tract infections (UTIs) are frequently diagnosed in the Emergency Departments (EDs) in Saudi Arabia. Despite their prevalence, there is a lack of localized data on antibiotic prescribing practices for UTIs in EDs, hampering optimal patient care and antibiotic resistance management. Objective: This study aimed to evaluate the appropriateness of antibiotic prescriptions for UTI patients by examining adherence to treatment guidelines at a tertiary care ED in Saudi Arabia. Methods: A retrospective cohort analysis was performed in UTI patients with ≥18 years of age who were presented to the ED at a tertiary care hospital between January 2022 and January 2023. 179 patients were randomly selected for enrollment, and data related to their demographics, medical history, microbial isolation, administered antibiotics, and incidence of recurrent infections were collected. Results: Ciprofloxacin (38 %), Cefuroxime (26.8 %), and Nitrofurantoin (16.8 %) were the most prescribed antibiotics. The female population accounted for 87.3 % of UTI cases. Notably, 40.7 % lacked microbial growth or data. Inappropriateness was found in 55.3 % of selection, 27.9 % of dosing, and 38.5 % of treatment duration confined to antibiotics in UTI management. Moreover, complicated UTIs rather than duration and indication for antibiotic therapy were independent risk factors for the re-occurrence of UTIs. Conclusions: The study depicted an overall 44.7 % of appropriate antibiotic prescriptions in UTI patients. However, it also highlighted the necessity for tailored interventions and promotional efforts aimed at promoting the rational use of antibiotics in patients, thereby preventing resistance and treatment failure.

Keywords

• Urinary tract infection
• Antibiotic resistance
• Infection control
• Antimicrobial stewardship
• Emergency department
• Recurrent infections