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Fésüs A, Matuz M, Papfalvi E, Hambalek H, Ruzsa R, Tánczos B, Bácskay I, Lekli I, Illés Á, Benkő R. Evaluation of the Diagnosis and Antibiotic Prescription Pattern in Patients Hospitalized with Urinary Tract Infections: Single-Center Study from a University-Affiliated Hospital. Antibiotics (Basel) 2023; 12:1689. [PMID: 38136723 PMCID: PMC10741002 DOI: 10.3390/antibiotics12121689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/21/2023] [Accepted: 11/29/2023] [Indexed: 12/24/2023] Open
Abstract
UTIs (urinary tract infections) are common bacterial infections with a non-negligible hospitalization rate. The diagnosis of UTIs remains a challenge for prescribers and a common source of misdiagnosis. This retrospective observational study aimed to evaluate whether recorded diagnosis by clinicians and empirical antibiotic therapy met the EAU (European Association of Urology) guideline in patients hospitalized with UTI. The study was conducted at an internal medicine unit of a tertiary care medical center in Hungary. The diagnosis was assessed based on clinical presentation, physical examination, and laboratory (including microbiological) results, considering all the potential risk factors. Diagnosis was considered misdiagnosis when not confirmed by clinical presentation or clinical signs and symptoms. Evaluation of empirical antibiotic therapy was performed only for confirmed UTIs. Empirical treatment was considered guideline-adherent when complying with the relevant recommendations. Out of 185 patients, 41.6% failed to meet EAU-based UTI diagnosis criteria, of which 27.6% were misdiagnosed and 14.1% were ABU (asymptomatic bacteriuria). The diagnosis of urosepsis recorded at admission (9.7%, 18/185) was not confirmed either by clinical or microbiological tests in five (5/18) cases. The initial empirical therapies for UTI showed a relatively low rate (45.4%) of guideline adherence regarding agent selection. The most common guideline-non-adherent therapies were combinations with metronidazole (16.7%). Dosage appropriateness assessments showed a guideline adherence rate of 36.1%, and underdosing due to high body weight was common (9.3%). Overall (agent, route of administration, dose, duration) guideline adherence was found to be substantially low (10.2%). We found a relatively high rate of misdiagnosed UTIs. Written protocols on the ward may be crucial in reducing misdiagnosis and in optimizing antibiotic use.
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Affiliation(s)
- Adina Fésüs
- Department of Pharmacology, Faculty of Pharmacy, University of Debrecen, H-4032 Debrecen, Hungary; (A.F.); (B.T.); (I.L.)
- Department of Pharmaceutical Technology, Faculty of Pharmacy, University of Debrecen, H-4032 Debrecen, Hungary;
- Institute of Healthcare Industry, University of Debrecen, H-4032 Debrecen, Hungary
| | - Mária Matuz
- Clinical Pharmacy Department, Faculty of Pharmacy, University of Szeged, H-6725 Szeged, Hungary; (M.M.); (E.P.); (H.H.); (R.R.)
- Central Pharmacy, Albert Szent Györgyi Medical Center, University of Szeged, H-6725 Szeged, Hungary
| | - Erika Papfalvi
- Clinical Pharmacy Department, Faculty of Pharmacy, University of Szeged, H-6725 Szeged, Hungary; (M.M.); (E.P.); (H.H.); (R.R.)
- Department of Emergency Medicine, Albert Szent Györgyi Medical Center, University of Szeged, H-6725 Szeged, Hungary
| | - Helga Hambalek
- Clinical Pharmacy Department, Faculty of Pharmacy, University of Szeged, H-6725 Szeged, Hungary; (M.M.); (E.P.); (H.H.); (R.R.)
| | - Roxána Ruzsa
- Clinical Pharmacy Department, Faculty of Pharmacy, University of Szeged, H-6725 Szeged, Hungary; (M.M.); (E.P.); (H.H.); (R.R.)
| | - Bence Tánczos
- Department of Pharmacology, Faculty of Pharmacy, University of Debrecen, H-4032 Debrecen, Hungary; (A.F.); (B.T.); (I.L.)
| | - Ildikó Bácskay
- Department of Pharmaceutical Technology, Faculty of Pharmacy, University of Debrecen, H-4032 Debrecen, Hungary;
- Institute of Healthcare Industry, University of Debrecen, H-4032 Debrecen, Hungary
| | - István Lekli
- Department of Pharmacology, Faculty of Pharmacy, University of Debrecen, H-4032 Debrecen, Hungary; (A.F.); (B.T.); (I.L.)
| | - Árpád Illés
- Department of Internal Medicine, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary;
| | - Ria Benkő
- Clinical Pharmacy Department, Faculty of Pharmacy, University of Szeged, H-6725 Szeged, Hungary; (M.M.); (E.P.); (H.H.); (R.R.)
- Central Pharmacy, Albert Szent Györgyi Medical Center, University of Szeged, H-6725 Szeged, Hungary
- Department of Emergency Medicine, Albert Szent Györgyi Medical Center, University of Szeged, H-6725 Szeged, Hungary
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Russo E, Di Bari S, Agnoletti V. Benefits of patient risk stratification and targeted interventions on multidrug resistant pathogens prevention and control. DISCOVER HEALTH SYSTEMS 2022; 1:6. [PMID: 37521116 PMCID: PMC9664758 DOI: 10.1007/s44250-022-00006-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 10/20/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Emanuele Russo
- Anesthesia and Intensive Care Unit, Bufalini Hospital, AUSL della Romagna, Cesena, Italy
| | - Silvia Di Bari
- Anesthesia and Intensive Care Department, Alma Mater Studiorum - Università di Bologna, Azienda Ospedaliero-Universitaria di Bologna IRCCS, via Giuseppe Massarenti 9, 40138 Bologna, Italy
| | - Vanni Agnoletti
- Anesthesia and Intensive Care Unit, Bufalini Hospital, AUSL della Romagna, Cesena, Italy
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