Abstract
BackgroundHealth care-associated urinary tract infection (HAUTI) consists of unique conditions (cystitis, pyelonephritis and urosepsis). These conditions could have different pathogen diversity and antibiotic resistance impacting on the empirical antibiotic choices. The aim of this study is to compare the estimated chances of coverage of empirical antibiotics between conditions (cystitis, pyelonephritis and urosepsis) in urology departments from Europe.MethodsA mathematical modelling based on antibiotic susceptibility data from a point prevalence study was carried. Data were obtained for HAUTI patients from multiple urology departments in Europe from 2006 to 2017. The primary outcome of the study is the Bayesian weighted incidence syndromic antibiogram (WISCA) and Bayesian factor. Bayesian WISCA is the estimated chance of an antibiotic to cover the causative pathogens when used for first-line empirical treatment. Bayesian factor is used to compare if HAUTI conditions did or did not impact on empirical antibiotic choices.ResultsBayesian WISCA of antibiotics in European urology departments from 2006 to 2017 ranged between 0.07 (cystitis, 2006, Amoxicillin) to 0.89 (pyelonephritis, 2009, Imipenem). Bayesian WISCA estimates were lowest in urosepsis. Clinical infective conditions had an impact on the Bayesian WISCA estimates (Bayesian factor > 3 in 81% of studied antibiotics). The main limitation of the study is the lack of local data.ConclusionsOur estimates illustrate that antibiotic choices can be different between HAUTI conditions. Findings can improve empirical antibiotic selection towards a personalized approach but should be validated in local surveillance studies.
Highlights
Health care-associated urinary tract infection (HAUTI) is a major concern with a prevalence of 7.7% (4.6–17.3%) in urology departments, which is higher compared to other departments (0.5–1.7%) [1,2,3,4]
During the 12-year surveillance, 18,447 patients were screened in Europe and HAUTI was documented in 9.6% (n 1767) of them, which 7.6% (n 1398) were confirmed with culture tests
Nephrostomies, ureteral stents and ureteric stones were more common in pyelonephritis and urosepsis compared to cystitis (p = 0.000, Supplement VI)
Summary
Health care-associated urinary tract infection (HAUTI) is a major concern with a prevalence of 7.7% (4.6–17.3%) in urology departments, which is higher compared to other departments (0.5–1.7%) [1,2,3,4]. HAUTIs consist of three main clinical conditions that include cystitis, pyelonephritis and urosepsis. Health care-associated urinary tract infection (HAUTI) consists of unique conditions (cystitis, pyelonephritis and urosepsis). These conditions could have different pathogen diversity and antibiotic resistance impacting on the empirical antibiotic choices. The aim of this study is to compare the estimated chances of coverage of empirical antibiotics between conditions (cystitis, pyelonephritis and urosepsis) in urology departments from Europe. Clinical infective conditions had an impact on the Bayesian WISCA estimates (Bayesian factor > 3 in 81% of studied antibiotics). Findings can improve empirical antibiotic selection towards a personalized approach but should be validated in local surveillance studies
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