The Impact of Emergency Department Antibiotic Discordance on the Outcomes of Hospitalized Patients with Urinary Tract Infections: A Multi-Center Retrospective Cohort Study

TL;DR

This study examines how using antibiotics that match the infection's sensitivity in UTI patients affects hospital outcomes, finding shorter recovery times with concordant treatment.

Contribution

The study provides new evidence on the impact of antibiotic concordance on hospitalization duration for UTI patients.

Findings

Concordant antibiotic treatment was associated with shorter hospital stays compared to discordant treatment.

Ertapenem showed the highest concordance rate, while Cefazolin had the lowest.

Mortality and ICU stay rates were not significantly different between concordant and discordant groups.

Abstract

Urinary tract infections (UTIs), particularly complicated ones, contribute significantly to emergency department (ED) visits and demand prompt treatment due to risks such as urosepsis. The effect of antibiotic concordance on patient outcomes with UTIs is unknown. We conducted a retrospective analysis from 2014 to 2023, focusing on those who received antibiotics for at least three days and had positive urine cultures. Patients were matched using propensity score matching to compare outcomes between those receiving concordant and discordant empirical antibiotics. We conducted propensity score matching to compare groups based on the initial empirical antibiotic’s pathogen sensitivity (concordant vs. discordant). Within our results, Escherichia coli emerged as the predominant pathogen (64.8%), but concordance varied widely among antibiotics, with Ertapenem showing the highest (91.3%) and Cefazolin showing the lowest rates (21.5%). There was no significant difference in mortality rates or ICU stays between the concordant and discordant groups. However, the hospital stay duration was notably shorter (11.5 ± 9.2 vs. 12.2 ± 9.4 days, p < 0.05) for patients receiving concordant treatment, indicating a faster recovery. Our findings suggest that, while choosing concordant antibiotics might not significantly affect mortality, it might be associated with a shorter recovery period during hospitalization. Choosing concordant antibiotics based on patient severity and punctually updated local sensitivity reports might minimize healthcare costs, and prevent ED overcrowding.

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