[Adequacy of antibiotic therapy for urinary tract infection in a Medical Department from the university hospital of Lille: A retrospective cohort study].
BACKGROUND
The main objective of the study was to assess the adequacy of antibiotic therapy for urinary tract infections (UTI) in a French hospital medical department. The secondary objective was to identify factors associated with inadequacy of the antibiotic therapy.


METHODS
A retrospective single centre cohort study was performed in the Post-Emergency Medicine Department (PEMD) of the university hospital of Lille. All patients presenting with an UTI from May 2012 to April 2014 were included. Adequacy of antibiotic therapy was assessed with reference to local guidelines. Factors associated with inadequacy of antibiotic prescription were determined using a multivariate logistic regression model.


RESULTS
Two hundred and twenty-eight patients were included. The antibiotic prescription was fully adequate in 173 patients (76%) with appropriate use of a single or a combination antibiotic therapy in 96%, appropriate drug in 80%, appropriate dosage in 89% and appropriate route of administration in 95%. The risk for antibiotic inadequacy was significantly higher in patients with cystitis than in those with pyelonephritis (OR 12.01; 95% CI 4.17-34.65), when antibiotics were prescribed in the Emergency Department (OR 6.84; 95% CI 2.29-20.47) or before hospital admission (OR 382.46; 95% CI 19.61≥999.99) compared to when antibiotics were first administered in the PEMD, and in patients with severe UTI (OR 19.55; 95% CI 2.79-137.01).


CONCLUSIONS
Adequacy of antibiotic therapy for UTI is relatively high in our study, reflecting the effective dissemination of antibiotic guidelines. However, antibiotic therapy is still inappropriate in cystitis, severe UTI and in case of prescription before the admission in the PEMD.
Service de médecine interne, CHRU de Lille, 2, avenue Oscar-Lambret, 59000 Lille, France. Electronic address: laurene.deconinck@yahoo.fr.
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L
Deconinck
Service de médecine interne, CHRU de Lille, 2, avenue Oscar-Lambret, 59000 Lille, France; Service de médecine polyvalente post-urgence, 2, avenue Oscar-Lambret, 59000 Lille, France.
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H
Maillard
Service de médecine polyvalente post-urgence, 2, avenue Oscar-Lambret, 59000 Lille, France; Service de gérontologie, CHRU de Lille, 2, avenue Oscar-Lambret, 59000 Lille, France.
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M
Lemaitre
Service de médecine polyvalente post-urgence, 2, avenue Oscar-Lambret, 59000 Lille, France.
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E
Barbottin
Service de médecine polyvalente post-urgence, 2, avenue Oscar-Lambret, 59000 Lille, France.
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E
Bakhache
Service de maladies infectieuses, CHRU de Lille, 2, avenue Oscar-Lambret, 59000 Lille, France.
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T
Galperine
Service de gérontologie, CHRU de Lille, 2, avenue Oscar-Lambret, 59000 Lille, France.
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Puisieux
Service de médecine interne, CHRU de Lille, 2, avenue Oscar-Lambret, 59000 Lille, France.
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Hatron
Service de médecine interne, CHRU de Lille, 2, avenue Oscar-Lambret, 59000 Lille, France; Service de médecine polyvalente post-urgence, 2, avenue Oscar-Lambret, 59000 Lille, France.
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M
Lambert
D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D003556:Cystitis / Q000188:drug therapy; D004636:Emergency Service, Hospital; D005260:Female; D005602:France; D019983:Guideline Adherence; D006785:Hospitals, University; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D008297:Male; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014552:Urinary Tract Infections / Q000188:drug therapy*
D000900:Anti-Bacterial Agents
Adéquation aux recommandations; Anti-bacterial agents; Antibiotique; Guideline adherence; Infection urinaire; Pratiques professionnelles; Professional practices; Urinary tract infections