Background: Antimicrobial stewardship has become an area of increasing concern due to the rising numbers of inappropriate antibiotic prescribing. Urinary tract infections (UTIs) were the fifth highest diagnosis for emergency department (ED) visits in Canada for 20111. Patients diagnosed with asymptomatic bacteriuria (ASB) are often inappropriately prescribed an antibiotic(s) in 80% of cases2. The purpose of this investigation was to inform administration, prescribers, pharmacists and other allied health workers on the current state of antimicrobial prescribing surrounding UTIs, and to measure the impact of regular reporting on patient outcomes and appropriate antimicrobial prescribing.
Methods: A retrospective chart audit of 309 admissions was conducted on patients who presented to the Strathcona Community Hospital emergency department (Sherwood Park, Alberta, Canada) between July and October 2015 with UTI symptoms. The primary outcome was antibiotic prescribing concordance to current practice guidelines, which included (but not limited to): Infectious Diseases Society of America (IDSA), Bugs & Drugs, Towards Optimized Practice (TOP), and Alberta Health Services (AHS) Drugs & Therapeutic Backgrounders (DTB). Secondary outcomes include UTI symptoms and diagnoses documented in the ED charts, antimicrobial orders, hydration status, urine investigations completed, and frequency of specific pathogens grown.
Results: Overall, 97% of UTI related admissions resulted in an ordered antimicrobial. The majority of the antimicrobial prescribing in the ED was non-concordant to guidelines (63%). Patients did not receive follow-up for negative cultures, resulting in 29% of the non-concordance. Of all patients reviewed, 22% demonstrated asymptomatic bacteriuria (ASB) or had syndromes inconclusive of UTI. Ciprofloxacin was the most frequently ordered antimicrobial (27%).
Conclusion: Audit results have demonstrated a need to engage the ER healthcare team in an effort to improve the diagnosis and treatment of UTI.
Figure 9 Ð Cluster Chart of UTI Cases, Concordance, and Initial Antimicrobials Prescribed