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Appropriate antibiotic use for patients with urinary tract infections reduces length of hospital stay.
Clin Infect Dis. 2013 Oct 24;
Authors: Spoorenberg V, Hulscher ME, Akkermans RP, Prins JM, Geerlings SE
Abstract
Background. To define appropriate antibiotic use for patients with a complicated urinary tract infection (UTI), we developed in a previous study a key set of four valid, guideline-based quality indicators (QIs). In the current study, we evaluated the association between appropriate antibiotic use for patients with a complicated UTI, as defined by these QIs, and length of hospital stay (LOS). Methods. A retrospective, observational multicentre study included 1,252 patients with a complicated UTI, hospitalized at Internal Medicine and Urology departments of 19 university and non-university Dutch hospitals. Data from the patients' medical charts were used to calculate QI performance scores. Multilevel mixed model analyses were performed to relate LOS to QI performance (appropriate use or not). We controlled for the potential confounders gender, age, (urological) comorbidity, febrile UTI and ICU admission<24 h. Results. Prescribing therapy in accordance with local hospital guidelines was associated with a shorter LOS (7.3 days vs. 8.7 days; P=0.02), as was early intravenous-oral switching (4.8 days vs. 9.1 days; P<0.001). There was an inverse relationship between the proportion of appropriate use in a patient (QI sumscore/number of applicable QIs) and LOS (9.3 days for lower tertile vs. 7.2 days for upper tertile; overall P<0.05). Conclusion. Appropriate antibiotic use in patients with a complicated UTI seems to reduce length of hospital stay and therefore favours patient outcome and health care costs. In particular, adherence to the total set of QIs showed a significant dose-response relationship with a shorter LOS.
PMID: 24158412 [PubMed - as supplied by publisher]