Antiobiotic Stewardship, Emerging Infectious Disease, Urinary Tract Infections
Conditions
Keywords
Urinary tract infection, Urine culture and sensitivity tests, Antimicrobial stewarship, Side effect and adverse event of antibiotics, Fluoroquinolones and 3rd-generation cephalosporins
Brief summary
Prospective, multicenter, non-interventional study conducted over 6 months, including patients presenting to the emergency department with suspected urinary tract infection managed as outpatients and discharged with or without empiric antibiotic therapy. Discharge antibiotic prescriptions are reviewed, with subsequent reassessment and optimization of treatment based on urine culture and susceptibility results
Detailed description
Urinary tract infections are a frequent cause of emergency department visits, accounting for substantial antibiotic use. Data from the OSCOUR (Organisation de la Surveillance Coordonnée des Urgences) network estimate around 5,000 weekly visits. Resistance rates among Enterobacteriaceae in urine samples are particularly high, largely driven by the widespread use of broad-spectrum antibiotics, especially fluoroquinolones, which are commonly prescribed as empiric therapy. Given their potential for serious adverse effects and their strong selective pressure for resistance, stricter control of their use is warranted, yet remains insufficient. In current emergency practice, conditions such as pyelonephritis or male urinary tract infections are often treated with broad-spectrum antibiotics that are continued even when pathogens are susceptible to narrower agents. De-escalation to narrower-spectrum therapies would help preserve the microbiota and limit resistance. This study is a prospective, multicenter, non-interventional observational study conducted over 6 months. It includes patients presenting to the emergency department with suspected urinary tract infections managed on an outpatient basis and discharged with or without empiric antibiotic therapy. Antibiotic treatments are reassessed 48 - 72 hours after inclusion by a physician, allowing for patient follow-up and potential modification of the initial prescription based on urine culture and susceptibility results, in accordance with current guidelines. The study aims to assess the value of this reassessment strategy in improving antimicrobial stewardship for urinary tract infections in emergency settings and to inform future optimization of clinical practices.
Interventions
OTHERAdaptation of antibiotics therapy for outpatient urinary infection following emergency care
Re assessment of antibiotic therapy at 48 hours based on urine culture results : discontinuation or de-escalation to a narrower-spectrum agent
Sponsors
Centre Hospitalier Intercommunal Creteil
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age 18 years or over * Patients presenting at emergency department, with symptoms suggestive of a urinary tract infection suitable for outpatient management (uncomplicated cystitis or cystitis at risk of complications, uncomplicated pyelonephritis or pyelonephritis at risk of complications, male urinary tract infection with or without fever) who have had a urine culture taken
Exclusion criteria
* Refusal to participate in the study * Vulnerable person (person under guardianship or trusteeship, minor, person deprived of liberty, person unable to express their refusal) * Pregnant women * Severe urinary tract infection (sepsis, septic shock or requiring drainage, except for low urinary catheterisation) * Hospitalisation for a urinary tract infection or decompensation of another comorbidity * Suspected urinary tract infection without a urine culture having been performed
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Assess changes in fluoroquinolone and third-generation cephalosporin prescribing in outpatient urinary tract infections following adjustment based on urine culture and susceptibility results. | At 48 hours - 72 hours after the patient inclusion |
Secondary
| Measure | Time frame |
|---|---|
| Incidence (percentage) of adverse effects associated with antibiotics. | At 1 month after the consultation in the Emergency department |
| Incidence (percentage) of antibiotic prescription savings in the Emergency department for outpatient urinary tract infections (cessation of prescription, shortening of treatment duration and/or narrowing of the spectrum) following the intervention | At 48 hours - 72 hours after the patient inclusion |
| Assessment of patient satisfaction with medical follow-up via a question asked directly to the patient via a questionnaire (Better if more than 50 percent of patients are satisfied) | At 1 month after the consultation in the Emergency department |
| Assessment of patients' knowledge of antibiotic resistance via a question asked directly to the patient via a questionnaire (Better if more than 50 percent of patients are satisfied) | At 1 month after the consultation in the Emergency department |
Countries
France
Contacts
CONTACTAnna BELKACEM, MD
CONTACTWissem TOUADI, Resident
Outcome results
None listed