Methods: This retrospective, single-center study included adults presenting to the ED and discharged home from 9/2015 through 8/2017 with a primary diagnosis of UTI. Included patients had a diagnosis of a lower tract UTI (ICD-10 codes for acute cystitis (N30) and cystitis with or without hematuria (N30.90-91)). Excluded patients were not prescribed antibiotics or had an additional ICD-10 code for pyelonephritis (N10). Data from the electronic health record was used to categorize patients as uncomplicated or complicated. Allergies, recent antibiotic use and prior urine cultures were utilized when determining compliance with first-line (nitrofurantoin or fosfomycin) and second line (cephalexin or trimethoprim/sulfamethoxazole (TMP/SMX)) recommendations. The primary objective was to describe prescriber compliance with institutional UTI guidelines for both drug selection and duration.
Results: Of 658 UTI encounters included, the compliance rate for both appropriate drug selection and duration was 11.6%, with lower compliance to drug selection (17.6%) compared to duration (58.2%). The most commonly prescribed antibiotics included: cephalexin, TMP/SMX, and ciprofloxacin. Fluoroquinolones (FQs) comprised 24.2% of all antibiotics prescribed, yet only 2% were appropriate. Patients with uncomplicated UTIs had a lower compliance rate to appropriate drug duration compared to complicated UTIs (40.9% vs. 77.5%, p<0.001). No difference in outcomes were observed.
Conclusion: In the ED, both appropriate drug selection and duration for UTIs are low. Excessive durations of therapy and higher rates of FQs were common. Stewardship efforts in the ED should target both appropriate drug selection and duration as well as de-emphasize FQ use.
N. Dillman, None
P. Walker, None
J. Nagel, None