فهرست نشریات علمی دسترسی آزاد ایران

Background: Urinary tract infections are common diagnoses in adult emergency departments and account for a substantial proportion of antibiotic prescriptions. Inappropriate antibiotic use contributes to bacterial resistance, underscoring the need for local antimicrobial stewardship efforts. Objectives: This study aimed to assess compliance of antibiotic prescriptions for non-severe urinary tract infections with national guidelines and to examine local resistance patterns. Methods: This single-center retrospective study analyzed data from the medical records of adult patients with acute, noncomplicated urinary tract infections who attended the emergency department at Amiens-Picardie University Medical Center, Amiens, France, between January 1, 2021, and December 31, 2023. Compliance with the guidelines issued by the French Infectious Diseases Society (Société de Pathologie Infectieuse de Langue Française, SPILF) was evaluated with respect to the antibiotic molecule, dosing regimen, and treatment duration. Statistical analyses included descriptive statistics, bivariate tests (chi-squared test, Fisher exact test, t-test, and Mann-Whitney U test), and multivariate logistic regression to identify factors associated with noncompliance. A P value < 0.05 was considered statistically significant. Variables with P < 0.20 in bivariate analysis were included in the multivariate model. Multicollinearity was assessed using the Belsley-Kuh-Welsch technique, and heteroskedasticity and residual normality were tested using the White test and Shapiro-Wilk test, respectively. Results: Overall, 456 patients were included, of whom 338 (74.1%) were female. The median age was 41 years (31 to 58). Empirical antibiotic therapy was initiated in 437 patients (95.8%). Fluoroquinolones were the most frequently prescribed antibiotics: ciprofloxacin in 106 patients (24.3%), ofloxacin in 51 (11.7%), and levofloxacin in 39 (8.9%). Third-generation cephalosporins were prescribed as first-line treatment in 51 patients (11.7%). Prescription compliance was significantly lower for male urinary tract infections (30.5%) than for cystitis (80.3%) and acute pyelonephritis (54.1%). Fluoroquinolones were also the most frequently inappropriately prescribed antibiotics (n = 194 [42.5%]). Multivariate analysis identified cystitis as being significantly associated with greater antibiotic prescription compliance in the emergency department (OR, 2.6; 95% CI, 1.42 - 4.75; P = 0.002). Escherichia coli was the predominant pathogen (n = 247 [76.2%]), including 18 fluoroquinolone-resistant strains and 12 extended-spectrum beta-lactamase-producing strains. Conclusions: Slightly more than half of antibiotic prescriptions for non-severe urinary tract infections in an emergency department complied with national guidelines, with particularly low compliance for male urinary tract infections and acute pyelonephritis. Enhanced antimicrobial stewardship is needed to optimize urinary tract infection management.