Assessment and Optimization of the Empiric Treatment of Urinary Tract Infections in an Academic Emergency Department Observation Unit

J Emerg Med. 2020 Feb;58(2):203-210. doi: 10.1016/j.jemermed.2019.12.021. Epub 2020 Mar 13.


Background: Poor adherence to evidence-based guidelines and overuse of broad-spectrum antibiotics has been noted in the emergency department (ED). There is limited evidence on guideline-congruent empiric therapy for urinary tract infections (UTIs) and uropathogen susceptibilities in the ED observation unit (EDOU).

Objective: The primary objective was to evaluate the prescribing patterns for the empiric treatment of UTI in the EDOU. Secondary objectives were to analyze uropathogen susceptibilities in the EDOU and implement an algorithm for the empiric treatment of UTI.

Methods: This study retrospectively reviewed adult patients who received empiric UTI treatment in the EDOU from January 1, 2018 to April 1, 2018. Eligible patients were categorized as having either uncomplicated or complicated cystitis, or pyelonephritis based on their clinical diagnosis. Antimicrobial therapy was evaluated in accordance with national practice guidelines, institutional guidelines, and local antimicrobial susceptibility patterns.

Results: Patients with uncomplicated or complicated cystitis (n = 115) were provided guideline-congruent empiric treatment in 87% of cases. Patients with pyelonephritis (n = 35) were provided guideline-congruent empiric treatment in 57% of cases. Susceptibility patterns of uropathogens isolated from this patient sample differed slightly from the institutional antibiogram, notably depicting a lower Escherichia coli susceptibility rate. Fluoroquinolones were prescribed for a longer than recommended duration in 18 patients (60%).

Conclusions: The majority of patients in this study were provided guideline-congruent empiric therapy. Nevertheless, there are opportunities to optimize empiric UTI treatment and improve antibiotic stewardship in the EDOU.

Keywords: UTI; antibiotic; stewardship.

MeSH terms

  • Academic Medical Centers
  • Aged
  • Aged, 80 and over
  • Algorithms
  • Anti-Bacterial Agents / therapeutic use*
  • Antimicrobial Stewardship*
  • Clinical Observation Units*
  • Emergency Service, Hospital*
  • Female
  • Guideline Adherence
  • Humans
  • Male
  • Microbial Sensitivity Tests
  • Middle Aged
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Retrospective Studies
  • Urinary Tract Infections / diagnosis
  • Urinary Tract Infections / drug therapy*


  • Anti-Bacterial Agents