New research presented at this week's European Congress of Clinical Microbiology & Infectious Diseases (ECCMID) in Amsterdam, Netherlands (13-16 April) has shown that urinary tract infection (UTI) syndromes are over-diagnosed in UK emergency departments (ED).
The study, carried out by University College London and the Hospitals Birmingham NHS Foundation Trust, included 943 patients with ED-diagnosed suspected UTI, of whom 671 (71%) were admitted. There were 289 patients with 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%) 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. More than 40 per cent (n=34) of these cases had a primary diagnostic code for a non-infectious condition, yet these individuals were prescribed 8.1 antibiotic defined daily doses (DDD) on average and treated with antibiotics for a median of 7.5 days.
The authors say concerns about over-delaying antibiotic treatment for severe infection means that clinicians have a low threshold for initiating empirical antibiotics in the ED for patients with suspected UTI syndromes.
They conclude 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.