The clinical rate of antibiotic change following empiric treatment for suspected urinary tract infections

Int Urol Nephrol. 2020 Mar;52(3):431-436. doi: 10.1007/s11255-019-02327-7. Epub 2019 Nov 5.

Abstract

Purpose: To determine the rate of antibiotic change in an outpatient setting following empiric treatment of culture proven UTI and to identify risk factors associated with change.

Methods: Patients with suspected UTI and urine culture were reviewed (January 2016-June 2016). Those with a positive culture were categorized by whether or not they were treated empirically. Empiric treatment was evaluated for associations with clinical-demographic data, symptoms and urinalysis (UA). Antibiotic change was evaluated with clinical-demographic data, urine culture, and resistance patterns.

Results: 916 urine cultures (636 patients) were included. 391 (43%) cultures were positive, and 164 (42%) were treated empirically. Clinical-demographic data did not differ between groups. Those treated empirically had more documented UTI symptoms (93 vs 58%, P < 0.001), and UA abnormalities including positive nitrites (51 vs 29%, P < 0.001), 3 + leukocyte esterase (27 vs 19%, P = 0.002) and 3 + blood (13 vs 4%, P = 0.005). Of those treated empirically, 42/164 (26%) required an antibiotic change, and this was associated with immunosuppression (12 vs 2%, P = 0.027) resistance to > 3 antibiotics (33 vs 20%, P = 0.039) and also resistance to fluoroquinolone (50 vs 30%, P = 0.016), monobactam (19 vs 7% P = 0.042) and TMP-SMX (52 vs 19%, P < 0.001).

Conclusions: Almost one-quarter of patients treated empirically required antibiotic change. This was driven largely by bacterial resistance. New technologies allowing rapid bacterial identification and sensitivity may improve patient care.

Keywords: Antibiotics; Antimicrobial resistance; Empiric treatment; Urinary tract infection.

MeSH terms

  • Anti-Bacterial Agents* / administration & dosage
  • Anti-Bacterial Agents* / adverse effects
  • Anti-Bacterial Agents* / classification
  • Drug Resistance, Microbial
  • Drug Substitution* / adverse effects
  • Drug Substitution* / methods
  • Drug Substitution* / statistics & numerical data
  • Early Diagnosis
  • Female
  • Humans
  • Male
  • Microbial Sensitivity Tests / methods*
  • Middle Aged
  • Outcome Assessment, Health Care
  • Quality Improvement
  • Risk Factors
  • Urinalysis / methods
  • Urinary Tract Infections* / diagnosis
  • Urinary Tract Infections* / drug therapy
  • Urinary Tract Infections* / microbiology

Substances

  • Anti-Bacterial Agents