LOS UTI ABx

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Spoorenberg V, et al. "Appropriate Antibiotic Use for Patients With Urinary Tract Infections Reduces Length of Hospital Stay". Cin Infect Dis. 2014. 58(2):164-9.
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Clinical Question

Bottom Line

Major Points

Guidelines

Design

  • Multicenter, observational, cohort study
  • N=1252
    • Urine culture (n=1284)
    • Guideline antibiotics (n=1165)
    • IV to PO step-down within 72 hours (n=542)
    • tailoring therapy (n=850)
  • Setting: 19 university, teaching, and nonteaching hospitals in the Netherlands
  • Enrollment: February to November 2009
  • Mean follow-up:
  • Analysis:
  • Primary Outcome: Length of stay

Population

Inclusion Criteria

  • adults (aged ≥16 years)
  • admitted / diagnosed with a complicated UTI
    • defined as: catheter-associated UTIs, male sex, any functional or anatomical abnormality of the urinary tract, pregnancy, immunocom- promising disease or medication, or a UTI with symptoms of tissue invasion or systemic infection (pyelonephritis, urosepsis, prostatitis)
  • whom antibiotic therapy initiated

Exclusion Criteria

  • hospital-acquired UTIs
  • UTIs without Dutch national guideline treatment recommendations (ie, UTIs in patients with a nephrostomy or after a urological procedure)
  • treatment for concurrent infection
  • transfer from/to another hospital
  • direct admission to ICU

Baseline Characteristics

  • Mean age: 63 years
  • male 41%
  • Urological comorbidity 22.9%
  • Mean length of stay 8 days
  • mortality 2.6%

Interventions

  • Patients who had 4 quality indicators of urinary tract infection care[1]:
    • Urine culture collected prior to initiation of treatment
    • Empiric antibiotics in accordance with national Dutch guideline
    • step-down from intravenous to oral treatment within 72 hours
    • tailoring therapy based on culture results

Outcomes

Comparisons are QI interventions vs. No QI intervention.


Primary Outcomes

Length of stay for all QI components
7.2 days vs. 9.3 days (P < 0.05)

Secondary Outcomes

Subgroup Analysis

Adverse Events

Criticisms

Funding

Further Reading

  1. Hermanides HS et al. Development of quality indicators for the antibiotic treatment of complicated urinary tract infections: a first step to measure and improve care. Clin. Infect. Dis. 2008. 46:703-11.