Adecuación del tratamiento empírico de la infección urinaria en urgencias

Abstract

Introduction To describe characteristics of urinary tract infections attended in an Emergency Department. To assess antibiotic prescription and inappropriate treatment implications. Methods Adults patients attended in an Emergency Department during 2 months with UTI confirmed with urocultive were included. Appropriate antibiotic treatment was considered if the first antibiotic used was sensitive. We compared patients with appropriate and inappropriate antibiotic treatment. A logistic regression was performed to evaluate variables associated to inappropriate antibiotic treatment. Results A total of 151 patients were included (61% women, 67.1[22.3] years). Comorbidity was present in 63% of patients. Urinary sepsis was the most frequent diagnosis (32.5%). E coli was isolated in 65.6% of cases, and 10% presented bacteremia. Percentage of inappropriate antibiotic treatment was 20.5. It was associated (uncontrolled analysis) with male gender, elder patients, recent urinary simptoms, urologic manipulation more than 1 month ago, previous antibiotic use (especially ciprofloxacin or amoxicillin-clavulanate) and presentation with urinary sepsis. Logistic regression analysis showed association only with age (HR 0.978 per year, CI95% 0.957–1, p=0.029) and previous antibiotic use (HR 0.298, CI95% 0.098–0.901, p=0.05). Patients with inappropriate antibiotic treatment did not have higher mortality. Conclusions Inappropriate antibiotic treatment for UTI in Emergency Department is relatively frequent and it is associated to older age and previous antibiotic use.