Simplified antibiotic guidelines in urology are associated with decreased multidrug-resistant Enterobacterales - 15/10/23
, Sylvaine Bastian c, Sébastien Breurec b, c, d, e, Marion Saliège f, Pascal Blanchet b, g, h, Laurent Brureau b, g, hHighlights |
• | We propose a simplified therapeutic guideline for UTI in urology. |
• | No previous study has audited antibiotic prescriptions for bacteremia in urology. |
• | Patients with bacteremia presented with nosocomial UTI due to multidrug-resistant (MDR) bacteria. |
• | Adherence to simplified therapeutic guideline was significant and associated with decreased MDR bacteria in blood culture. |
Abstract |
Purpose |
A simplified therapeutic guideline (STG) was established in our urology ward in 2019 for urinary infections. Our aim was to describe the level of physician adherence to STG and the impact of a limited number of antibiotic compounds on the rate of multidrug-resistant (MDR) bacteria. As guidelines should improve patient care, unfavorable outcomes were also reported.
Methods |
The STG for community-acquired and nosocomial urinary infections, including six antibiotics, was established in November 2019 and has been officially applied since January 2020. Treatment duration has to be ≤14 days. We conducted a before-after study to measure physician adherence to the STG for bacteremia treatment between January 2017 and December 2022. Adherence was defined as exclusive use of STG antibiotics. All isolated bacteria from blood cultures were recorded, including MDR Enterobacterales, defined as AmpC β-lactamase- or ESBL-producing strains. Unfavorable outcomes were defined as uncontrolled infection, a second surgical procedure, ICU requirement, and/or death.
Results |
Seventy-six cases of bacteremia occurred between January 2017 and December 2019, and ninety between January 2020 and December 2022. The main comorbid condition was urological cancer (46%). The main reason for surgery was ureteral stent (32%). Antibiotic management in accordance with STG increased from 18% to 52%, p < 0.001, and treatments > 14 days decreased from 53% to 28%, p < 0.001. MDR Enterobacterales bacteremia was reduced from 52% to 35%, p = 0.027. The rate of unfavorable outcomes was unchanged.
Conclusion |
STG adherence in urology was satisfactory and associated with reduced MDR Enterobacterales bacteremia.
Le texte complet de cet article est disponible en PDF.Keywords : Urology, Antimicrobial stewardship, Antibiotics, Bacteremia, Multidrug-resistance Enterobacterales
Plan
Vol 53 - N° 7
Article 104763- octobre 2023 Retour au numéro
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