287. Inappropriate Recommendations for Empirical Treatment of Patients with Complicated Urinary Tract Infections in the Dutch National Guideline
Session: Poster Abstract Session: Antimicrobial Therapy: Clinical Studies
Friday, October 21, 2011
Room: Poster Hall B1
Handouts
  • poster_empirischetherapie_def.png (292.8 kB)
  • Background: Expected pathogens and local resistance data are the basis for recommendations about the choice of empirical antibiotic treatment in guidelines. For complicated urinary tract infections (UTIs) the Dutch national guideline recommends for empirical treatment as first choices 2nd or 3rd generation cephalosporins, the combination of amoxicillin and gentamicin and, when the treatment is oral, ciprofloxacin. Second choice is amoxicillin-clavulanic acid. The aim of this study was to investigate the appropriateness of the guideline-recommended empirical antimicrobial therapy in a random, large sample of patients with complicated UTIs in 19 hospitals in the Netherlands. 

    Methods: Included were 808 patients from 19 hospitals all over the Netherlands with a complicated UTI and a positive urine culture. The susceptibility patterns of the uropathogens were compared to the recommended and actually given empirical treatment. We distinguished between inadequate coverage (e.g. cephalosporins for enterococci) and resistance (e.g. cephalosporin resistance in E.coli). We considered inadequate treatment rates below 10% as acceptable.

    Results: Overall, in 85% of the patients the uropathogen was susceptible to the given empirical antibiotic treatment. Of the isolated uropathogens 6% was not adequately treated by the combination of amoxicillin and gentamicin. Inadequate treatment rates for 2nd or 3rd generation cepholosporins were respectively 22% (inadequate coverage 12%, resistance 10%) and 15% (inadequate coverage 13%, resistance 2%), for amoxicillin-clavulanic acid 13% (inadequate coverage 5%, resistance 8%) and for ciprofloxacin 21% (inadequate coverage 7%, resistance 14%).

    Conclusion: Of the recommended empirical antimicrobial therapy in our national guideline only the combination of amoxicillin and gentamicin is appropriate. Taken into account these resistance data the Dutch national guideline for the treatment of complicated UTIs needs revision. The data also show that the performance of evidence-based antibiotic treatment guidelines needs to be verified in daily practice.


    Subject Category: A. Antimicrobial agents and Resistance

    Veroniek Spoorenberg, MD1,2, Marlies E.J.L. Hulscher, PhD2, Suzanne Geerlings, MD, PhD1 and Jan M. Prins, Professor, MD1, (1)Internal Med., Infectious Diseases, Tropical Med. and AIDS, Ctr. for Infection and Immunity Amsterdam (CINIMA), Academic Med. Ctr., Amsterdam, Netherlands, (2)IQ Healthcare, Radboud Univ. Nijmegen Med. Ctr, Nijmegen, Netherlands

    Disclosures:

    V. Spoorenberg, None

    M. E. J. L. Hulscher, None

    S. Geerlings, BMS,AstraZeneca Astellas: Scientific Advisor, Consulting fee

    J. M. Prins, None

    Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.