New UK research presented at the European Congress of Clinical Microbiology & Infectious Diseases (ECCMID) in Amsterdam, Netherlands (13-16 April) showed that only one third of patients that entered a UK emergency department (ED) with suspected urinary tract infection (UTI) actually had evidence of this infection, yet almost all were treated with antibiotics.
The authors undertook a cohort study in a large Birmingham teaching hospital, using electronic health records (EHRs) from patients with suspected UTI syndromes who attended the ED. Individuals who had a sampled microbiological culture of urine in the ED were eligible for inclusion. A subset of 1000 patients (700 admitted to hospital) were randomly selected. The researchers compared diagnoses made by the ED physician to clinical diagnosis based on urinary symptoms and microbiological outcomes and international classification of disease (ICD-10) diagnostic codes. Finally they estimated consumption of antibiotics in these patients.
A total of 943 patients were eligible for the study. Of these, 289 patients had an ED diagnosis of UTI syndromes including 56 cases of pyelonephritis, 42 cases of urosepsis, and 191 cases of lower UTI.
Treatment with empirical antibiotics was recorded for 173 (91%) of patients with an ED diagnosis of lower UTI, but only 66 cases (34.5%) had clinical evidence of UTI.
ICD-10 diagnostic codes were available for 83 patients with lower UTI who had been admitted to hospital. Of these, 34 out of 83 had a primary diagnostic code for a non-infectious condition, suggesting antibiotic treatment was not required.
The authors concluded that a “focus on antibiotic review in patients with an ED diagnosis of suspected UTI syndromes could support reductions in inappropriate antibiotic prescribing in secondary care.”