An evaluation of community-acquired urinary tract infection and appropriateness of treatment in an emergency department in Saudi Arabia

Abstract

IntroductionUrinary tract infection (UTI) is a serious health problem affecting millions of people every year. Inappropriate antibiotic prescriptions put patients at risk and lead to bacterial resistance and elevated costs.AimsStudy aims were to assess the prevalence and antibiotic-treatment patterns of community acquired UTIs, prevalence and types of antibiotic-prescribing errors, and the cost of inappropriate antibiotic use.MethodsThis was a retrospective cross-sectional study conducted over a 3-month period in an emergency department in Saudi Arabia.ResultsDuring the study period, 1,449 patients were diagnosed with UTIs, including pediatric (18.6%), adult (59.2%), and elderly (22.2%) patients. The overall prevalence of UTIs was 9.9% of total visits. Broad-spectrum antibiotics were prescribed for 85% of patients. Three main antibiotics were prescribed: cephalosporin (39%), penicillin (26%), and fluoroquinolone (22%). The overall prevalence of inappropriate antibiotic prescription with at least one type of error was 46.2% (pediatrics 51%, adults 46%, elderly 47%). Errors were dose (37%), duration (11%), frequency (6%), and antibiotic selection (2.4%). Dose error was significantly greater in pediatric patients (P=0.001). Duration error was higher among adults and the elderly (P=0.014). Significantly more inappropriate cephalosporin prescriptions were seen in adults (P=0.001), while penicillin had significantly higher errors in pediatric patients. Positive urine culture was seen in 34.9% of patients, and the most common microorganism was Escherichia coli (51%). The mean cost of care for one episode of UTI was US$134.56±$31.34 (95% CI $132.94–$136.17). Treatment of UTI was more costly in women (63.9% of total cost), adults (59.2%), and those using broad-spectrum antibiotics (86.5%). There were statistically significant associations among sex, age, spectrum of antibiotic, category of antibiotic, and inappropriate cost.ConclusionThe results revealed a significant level of inappropriate use of antibiotics in the treatment of UTIs in the emergency department.

Which patient should start empirical antibiotic treatment in urinary tract infection in emergency departments?

“…[ 21 ] In their study, also investigating the population under 18-year-old, Alanazi found that E. coli was highly sensitive to nitrofurantoin (92%), followed by ciprofloxacin (81.8%), amoxicillin–clavulanic acid (81.1%), and cefazolin (77.5%). [ 2 ] Moreover, they found a decreasing level of sensitivity of E. coli to co-trimoxazole (55.6%), followed by ampicillin (33.1%). [ 2 ] Rosa et al .…”

“…[ 2 ] Moreover, they found a decreasing level of sensitivity of E. coli to co-trimoxazole (55.6%), followed by ampicillin (33.1%). [ 2 ] Rosa et al . showed that E. coli isolates were sensitive to trimethoprim-sulfamethoxazol (54%) and to Fluoroquinolones (60%).…”

“…In Alanazi's study, the most commonly prescribed antibiotics in adults were cefuroxime (35.4%), norfloxacin (17.9%), and amoxicillin-clavulanic acid (16.6%), followed by amoxicillin (9.8%), nitrofurantoin (6.9%), co-trimoxazole (4.4%), and ciprofloxacin (4.1%). [ 2 ] Almulhim et al . stated that ciprofloxacin was most frequently prescribed at the rate of 36%–45% in their studies.…”

“…UTI remains one of the top 15 diagnoses made annually in ED as well as being a reason for frequent admission to hospitals. [ 2 ] In the USA, there are 7 million admissions due to UTI, with at least 1 million to EDs, and 100,000 patients are hospitalized every year due to the UTI. [ 3 ] Schappert and Rechtsteiner showed that 0.9% of nearly 10.5 million outpatient admissions in 2007 were due to UTIs, and 21.3% of these visits were made to hospital EDs.…”

Rapid Detection and Antibiotic Susceptibility of Uropathogenic Escherichia coli by Flow Cytometry

“…False-positive or false-negative results were therefore observed in a limited number of cases. The validation of the FC AST method on clinical urine samples collected from in-patients included two broad-spectrum antibiotic classes, frequently recommended for the emergency treatment of UTIs, i.e., fluoroquinolones (ciprofloxacin) and cephalosporins (ceftriaxone) [ 41 , 42 , 43 ]. The comparative analysis of the FC results with the reference method indicated 100% agreement between the results obtained by the standard assays and those provided by FC AST for ceftriaxone and only a few discrepancies for ciprofloxacin.…”