An evaluation of community-acquired urinary tract infection and appropriateness of treatment in an emergency department in Saudi Arabia

Abstract

Introduction

Urinary tract infection (UTI) is a serious health problem affecting millions of people every year. Inappropriate antibiotic prescriptions put patients at risk and lead to bacterial resistance and elevated costs.

Aims

Study aims were to assess the prevalence and antibiotic-treatment patterns of community acquired UTIs, prevalence and types of antibiotic-prescribing errors, and the cost of inappropriate antibiotic use.

Methods

This was a retrospective cross-sectional study conducted over a 3-month period in an emergency department in Saudi Arabia.

Results

During the study period, 1,449 patients were diagnosed with UTIs, including pediatric (18.6%), adult (59.2%), and elderly (22.2%) patients. The overall prevalence of UTIs was 9.9% of total visits. Broad-spectrum antibiotics were prescribed for 85% of patients. Three main antibiotics were prescribed: cephalosporin (39%), penicillin (26%), and fluoroquinolone (22%). The overall prevalence of inappropriate antibiotic prescription with at least one type of error was 46.2% (pediatrics 51%, adults 46%, elderly 47%). Errors were dose (37%), duration (11%), frequency (6%), and antibiotic selection (2.4%). Dose error was significantly greater in pediatric patients (P=0.001). Duration error was higher among adults and the elderly (P=0.014). Significantly more inappropriate cephalosporin prescriptions were seen in adults (P=0.001), while penicillin had significantly higher errors in pediatric patients. Positive urine culture was seen in 34.9% of patients, and the most common microorganism was Escherichia coli (51%). The mean cost of care for one episode of UTI was US$134.56±$31.34 (95% CI $132.94–$136.17). Treatment of UTI was more costly in women (63.9% of total cost), adults (59.2%), and those using broad-spectrum antibiotics (86.5%). There were statistically significant associations among sex, age, spectrum of antibiotic, category of antibiotic, and inappropriate cost.

Conclusion

The results revealed a significant level of inappropriate use of antibiotics in the treatment of UTIs in the emergency department.

Keywords:

• prevalence
• urinary tract infection
• antibiotic
• cost
• inappropriate antibiotic
• resistance
• antibiotics resistance

Acknowledgments

The author would like to acknowledge the King Abdullah International Medical Research Center (KAIMRC) for its support. Special thanks go to the KAIMRC Publication Office, Dr Ahmed Alaskar, Associate Dr Farha Nazir, and Dr Fulwah Y Alqahtani from the College of Pharmacy, King Saud University.

Authors contribution

MQA is responsible for the study concept, data analysis, drafting, revising the article, gave final approval of the version to be published, and agrees to be accountable for all aspects of the work.

Disclosure

The author reports no conflicts of interest in this work.