| Contributors: |
Macera, M.; Salvati, A.; Allegorico, E.; Monari, C.; Vanni, M.; D'Isanto, M.; Vitelli, N.; Delgado, F.; Nasta, C.; Mariniello, A.; Fabozzi, F.; Coppola, R.; Numis, F. G.; Guiotto, G.; Giordano, M.; Raucci, R.; Dello Vicario, F.; Nasti, R.; Onorato, L.; Coppola, N.; Giamattei, R.; Borrelli, G. M.; De Capua, L.; Esposito, F.; Russo, K.; Sciorio, R.; Miglietta, F.; Amelia, A.; Guida, I.; Femine, A. D.; Serrao, V.; Quaranta, N.; Santagata, A.; Amato, A.; Florio, M. T.; Palumbo, A.; Palumbo, F.; Morelli, R.; Migliaccio, B.; Rapuano, C.; Compagnone, N.; Carannante, A.; Aiello, S.; Bianco, P.; Cornelli, A.; De Luca, I.; Utily Study, Group |
| Description: |
Background The spread of antibiotic resistance makes it necessary to implement Antimicrobial Stewardship (AMS) Programs; the aim of this study is to evaluate the impact of an AMS program in the management of urinary tract infection (UTI) in emergency setting. Methods A prospective multicentre study was conducted enrolling all adult patients admitted to one of the 8 emergency departments participating in the study with a diagnosis of UTI from February 2023 to July 2024. Only one of the eight centers received a persuasive AMS program. The primary outcome evaluated was the prevalence of empirical antimicrobial prescription belonging to Access class according to WHO classification in AMS and non-AMS ED; secondary outcomes included the prevalence of etiologial diagnosis, the clinical response and seven-day and 30-day mortality rates. Results During the study period, 657 patients were enrolled, 135 in the AMS and 522 in the non-AMS group, with a median age of 71 years (IQR 58-79). Patients in the AMS group had a more severe disease with a higher rate of sepsis or septic shock at admission (p < 0.001). In the AMS group, the percentage of patients with a microbiological diagnosis was higher (67% vs 43.1% p < 0.001); regarding empirical antibiotic therapy, drugs of the Access class were more frequently prescribed as empirical treatment in the AMS group (48.3 vs 37%, p = 0.04). No statistically significant differences were observed in terms of 7- and 30-day mortality and 7-day clinical response between the 2 groups, despite the higher severity of patients in the AMS group. Conclusions In the centre where an AMS program was conducted, an increase in the number of positive urine cultures (67% vs 43.1%) has been observed, and a higher rate of prescriptions for Access class antibiotics. Further prospective data are needed to evaluate the impact of AMS intervention on antimicrobial prescribing in emergency setting. |