Abstract
BackgroundInappropriate use of antibiotics not only increases antibiotic resistance as collateral damage but also increases clinical failure rates and medical costs. The purpose of this study was to determine the relationship between the appropriateness of antibiotic prescription and outcomes of community-acquired acute pyelonephritis (CA-APN).MethodsA multicenter prospective cohort study was conducted at eight hospitals in Korea between September 2017 and August 2018. All hospitalized patients aged ≥ 19 years who were diagnosed with CA-APN on admission were recruited. The appropriateness of empirical and definitive antibiotics, as well as the appropriateness of antibiotic treatment duration and route of administration, was evaluated in accordance with the guideline and expert opinions. Clinical outcomes and medical costs were compared between patients who were administered antibiotics ‘appropriately’ and ‘inappropriately.’ResultsA total of 397 and 318 patients were eligible for the analysis of the appropriateness of empirical and definitive antibiotics, respectively. Of them, 10 (2.5%) and 18 (5.7%) were administered ‘inappropriately’ empirical and definitive antibiotics, respectively. Of the 119 patients whose use of both empirical and definitive antibiotics was classified as ‘optimal,’ 57 (47.9%) received antibiotics over a longer duration than that recommended; 67 (56.3%) did not change to oral antibiotics on day 7 of hospitalization, even after stabilization of the clinical symptoms. Patients who were administered empirical antibiotics ‘appropriately’ had shorter hospitalization days (8 vs. 10 days, P = 0.001) and lower medical costs (2381.9 vs. 3235.9 USD, P = 0.002) than those who were administered them ‘inappropriately.’ Similar findings were observed for patients administered both empirical and definitive antibiotics ‘appropriately’ and those administered either empirical or definitive antibiotics ‘inappropriately’.ConclusionsAppropriate use of antibiotics leads to better outcomes, including reduced hospitalization duration and medical costs.
Highlights
Inappropriate use of antibiotics increases antibiotic resistance as collateral damage and increases clinical failure rates and medical costs
Appropriate use of antibiotics leads to better outcomes, including reduced hospitalization duration and medical costs
Acute pyelonephritis (APN) is an upper Urinary tract infection (UTI) commonly caused by gramnegative Enterobacterales; Escherichia coli is the most common causative organism [5]
Summary
The purpose of this study was to determine the relationship between the appropriateness of antibiotic prescription and outcomes of community-acquired acute pyelonephritis (CA-APN). Inappropriate use of antibiotics increases antibiotic resistance as collateral damage and increases clinical failure rates and medical costs [1]. Once a pathogen acquires antimicrobial resistance, it erodes the effectiveness of antibiotics, leads to clinical failure, and increases medical costs [2]. To tackle such a vicious cycle, the antimicrobial stewardship program (ASP)—a set of multidisciplinary activities focused on the proper use of antimicrobials—has been established [3]. The use of appropriate antibiotics against the causative pathogen is important for achieving favorable treatment results
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