Ng Wing Yan Vivian, Chen Shou-Yen, Chen Hsien-Yi, Ng Chip-Jin, Gao Shi-Ying, Li Chih-Huang
Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan 33358, Taiwan.
College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan.
Life (Basel). 2025 Mar 26;15(4):545. doi: 10.3390/life15040545.
Urinary tract infections (UTIs), particularly complicated ones, contribute significantly to emergency department (ED) visits and demand prompt treatment due to risks such as urosepsis. The effect of antibiotic concordance on patient outcomes with UTIs is unknown. We conducted a retrospective analysis from 2014 to 2023, focusing on those who received antibiotics for at least three days and had positive urine cultures. Patients were matched using propensity score matching to compare outcomes between those receiving concordant and discordant empirical antibiotics. We conducted propensity score matching to compare groups based on the initial empirical antibiotic's pathogen sensitivity (concordant vs. discordant). Within our results, Escherichia coli emerged as the predominant pathogen (64.8%), but concordance varied widely among antibiotics, with Ertapenem showing the highest (91.3%) and Cefazolin showing the lowest rates (21.5%). There was no significant difference in mortality rates or ICU stays between the concordant and discordant groups. However, the hospital stay duration was notably shorter (11.5 ± 9.2 vs. 12.2 ± 9.4 days, < 0.05) for patients receiving concordant treatment, indicating a faster recovery. Our findings suggest that, while choosing concordant antibiotics might not significantly affect mortality, it might be associated with a shorter recovery period during hospitalization. Choosing concordant antibiotics based on patient severity and punctually updated local sensitivity reports might minimize healthcare costs, and prevent ED overcrowding.
尿路感染（UTIs），尤其是复杂性尿路感染，是急诊科就诊的重要原因，由于存在尿脓毒症等风险，需要及时治疗。抗生素一致性对尿路感染患者预后的影响尚不清楚。我们对2014年至2023年进行了一项回顾性分析，重点关注那些接受抗生素治疗至少三天且尿培养呈阳性的患者。使用倾向得分匹配法对患者进行匹配，以比较接受一致和不一致经验性抗生素治疗的患者之间的预后。我们进行倾向得分匹配，以根据初始经验性抗生素的病原体敏感性（一致与不一致）比较各组。在我们的研究结果中，大肠杆菌是主要病原体（64.8%），但不同抗生素之间的一致性差异很大，厄他培南的一致性最高（91.3%），头孢唑林的一致性最低（21.5%）。一致组和不一致组之间的死亡率或入住重症监护病房的时间没有显著差异。然而，接受一致治疗的患者住院时间明显更短（11.5±9.2天对12.2±9.4天，<0.05），表明恢复更快。我们的研究结果表明，虽然选择一致的抗生素可能不会显著影响死亡率，但可能与住院期间较短的恢复期有关。根据患者的严重程度并及时更新当地敏感性报告来选择一致的抗生素，可能会降低医疗成本，并防止急诊科过度拥挤。
