Infectious Diseases Unit, Meir Medical Center, Kfar Saba, Israel.
Infectious Diseases Unit, Meir Medical Center, Kfar Saba, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Am J Emerg Med. 2021 Nov;49:10-13. doi: 10.1016/j.ajem.2021.05.037. Epub 2021 May 18.
Urinary tract infection (UTI) is frequently encountered in the emergency department (ED). We assessed an antibiotic stewardship intervention tailored for the ED. The primary objective was improving overall adherence to agent choice and treatment duration. The secondary objective was a decrease in fluoroquinolone prescription.
This pre-post study included patients discharged from the ED with a UTI diagnosis. The intensive intervention period lasted three months and involved dissemination of guidelines, short lectures, incorporation of order sets into electronic ED charts and weekly personal audit and feedback. The following 11-month phase was a booster period consisting of monthly text messages of the treatment protocol. Assessment of adherence to the protocol was compared between the three-month pre-intervention period and the last two months of the intensive intervention period, as well as with the last two months of the booster period.
A total of 177 patients were included in the pre-intervention period, 156 in the intervention period, and 94 in the late follow-up assessing the booster period. Median age was 49 (18-94) years, 78.2% were female, 84.8% had cystitis. During the intervention period, protocol adherence with antibiotic selection and duration increased from 41% to 84% (p < 0.001). Adherence remained high in the late follow-up period (73.4% vs. 41%, p < 0.001). Fluoroquinolone use decreased from 19.1% pre-intervention, to 5% in the intervention and 7.4% in the late follow-up periods (p < 0.001).
An antibiotic stewardship intervention in a busy ED resulted in adherence to treatment protocols, including a decrease in fluoroquinolone use. A monthly reminder preserved most of the effect for a year.
尿路感染（UTI）在急诊科（ED）中经常遇到。我们评估了针对 ED 的抗生素管理干预措施。主要目标是提高整体药物选择和治疗时间的依从性。次要目标是减少氟喹诺酮类药物的处方。
这项前后研究包括从 ED 出院的 UTI 诊断患者。强化干预期持续三个月，包括传播指南、简短讲座、将医嘱集纳入电子 ED 图表以及每周进行个人审核和反馈。接下来的 11 个月是强化期，每月发送一次治疗方案的短信。在三个月的干预前期间和强化干预期的最后两个月，以及强化期的最后两个月，评估对方案的依从性。
共有 177 例患者纳入干预前期间，156 例患者纳入干预期间，94 例患者在后期随访评估强化期。中位年龄为 49（18-94）岁，78.2%为女性，84.8%为膀胱炎。在干预期间，抗生素选择和疗程的方案依从性从 41%提高到 84%（p<0.001）。在后期随访期间，依从性仍然很高（73.4%比 41%，p<0.001）。氟喹诺酮类药物的使用从干预前的 19.1%减少到干预期间的 5%和后期随访期间的 7.4%（p<0.001）。
在繁忙的 ED 中进行抗生素管理干预措施，可提高治疗方案的依从性，包括减少氟喹诺酮类药物的使用。每月提醒可保留大部分效果一年。
