Abstract
BackgroundSuspected urinary tract infection (UTI) syndromes are a common reason for empirical antibiotics to be prescribed in the Emergency Department (ED), but differentiating UTI from other conditions with a similar presentation is challenging. We investigated how often an ED diagnosis of UTI is confirmed clinically/microbiologically, and described conditions which present as UTI syndromes.MethodsObservational study using electronic health records from patients who attended the ED with suspected UTI and had a urine sample submitted for culture. We compared the ED diagnosis to diagnosis at discharge from hospital (ICD-10 codes), and estimated the proportion of cases with clinical/microbiological evidence of UTI.ResultsTwo hundred eighty nine patients had an ED diagnosis of UTI syndrome comprising: lower UTI (191), pyelonephritis (56) and urosepsis (42). In patients admitted to hospital with an ED diagnosis of lower UTI, pyelonephritis or urosepsis, clinical/microbiological evidence of UTI was lacking in 61/103, 33/54 and 31/42 cases respectively. The ED diagnosis was concordant with the main reason for admission in less than 40% of patients with UTI syndromes, and antibiotics were stopped within 72 h in 37/161 patients.ConclusionsClinical/microbiological evidence of UTI was lacking in 60–70% of patients, suggesting scope to revise empirical prescribing decisions for UTI syndromes in light of microbial culture and clinical progression.
Highlights
Suspected urinary tract infection (UTI) syndromes are a common reason for empirical antibiotics to be prescribed in the Emergency Department (ED), but differentiating UTI from other conditions with a similar presentation is challenging
Using electronic health records supplemented by medical note review, we set out to estimate the frequency of over-diagnosis of UTI syndromes in the ED, and to describe the conditions which present as UTI in the ED in order to estimate the potential to reduce antibiotic prescribing by stopping antibiotics early in patients with no evidence of bacterial infection
Patients who were discharged from the ED were more likely to have a positive urinalysis compared to patients who were admitted to hospital (72.1% versus 66.4%)
Summary
Suspected urinary tract infection (UTI) syndromes are a common reason for empirical antibiotics to be prescribed in the Emergency Department (ED), but differentiating UTI from other conditions with a similar presentation is challenging. We investigated how often an ED diagnosis of UTI is confirmed clinically/ microbiologically, and described conditions which present as UTI syndromes. Urinary tract infection syndromes are a major cause of ED attendance and hospital admission [1]. Using electronic health records supplemented by medical note review, we set out to estimate the frequency of over-diagnosis of UTI syndromes in the ED, and to describe the conditions which present as UTI in the ED in order to estimate the potential to reduce antibiotic prescribing by stopping antibiotics early in patients with no evidence of bacterial infection
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
