• Am J Emerg Med · Feb 2021

    Multicenter Study

    Antibiotic prescribing for adult bacteriuria and pyuria in community hospital emergency departments.

    • John J Veillette, C Dustin Waters, Stephanie S Gelman, Lisa Hoopes, George Vargyas, Alyssa McKay, Tatiana Good, Jared Olson, and Todd J Vento.
    • Infectious Diseases Telehealth Service, Intermountain Healthcare, Intermountain Medical Center, Murray, UT, USA; Department of Pharmacy, Intermountain Healthcare, Intermountain Medical Center, Murray, UT, USA. Electronic address: john.veillette@imail.org.
    • Am J Emerg Med. 2021 Feb 1; 40: 1-5.

    ObjectiveTo describe emergency department (ED) antibiotic prescribing for urinary tract infections (UTIs) and asymptomatic bacteriuria (ASB) and to identify improvement opportunities.MethodsPatients treated for UTI in 16 community hospital EDs were reviewed to identify prescribing that was unnecessary (any treatment for ASB, duration >7 days for cystitis or >14 days for pyelonephritis) or suboptimal [ineffective antibiotics (nitrofurantoin/fosfomycin) or duration <7 days for pyelonephritis]. Duration criteria were based on recommendations for complicated UTI since criteria for uncomplicated UTI were not reviewed. 14-day repeat ED visits were evaluated.ResultsOf 250,788 ED visits, UTI was diagnosed in 13,466 patients (5%), and 1427 of these (11%) were manually reviewed. 286/1427 [20%, 95% CI: 18-22%] met criteria for ASB and received 2068 unnecessary antibiotic days [mean (±SD) 7 (2) days]. Mean treatment duration was 7 (2) days for cystitis and 9 (2) days for pyelonephritis. Of 446 patients with cystitis, 128 (29%) were prescribed >7 days (total 396 unnecessary). Of 422 pyelonephritis patients, 0 (0%) were prescribed >14 days, 20 (5%) were prescribed <7 days, and 9 (2%) were given ineffective antibiotics. Overall, prescribing was unnecessary or suboptimal in 443/1427 [31%, 95% CI: 29-33%] resulting in 2464/11,192 (22%) unnecessary antibiotic days and 8 (0.5%) preventable ED visits.ConclusionsAmong reviewed patients, poor UTI prescribing in 16 EDs resulted in unnecessary antibiotic days and preventable readmissions. Key areas for improvement include non-treatment of ASB and shorter durations for cystitis.Copyright © 2020 Elsevier Inc. All rights reserved.

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