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Background <p>The spread of antibiotic resistance makes it necessary to implement Antimicrobial Stewardship (AMS) Programs; the aim of this study is to evaluate the impact of an AMS program in the management of urinary tract infection (UTI) in emergency setting.</p> Methods <p>A prospective multicentre study was conducted enrolling all adult patients admitted to one of the 8 emergency departments participating in the study with a diagnosis of UTI from February 2023 to July 2024. Only one of the eight centers received a persuasive AMS program. The primary outcome evaluated was the prevalence of empirical antimicrobial prescription belonging to Access class according to WHO classification in AMS and non-AMS ED; secondary outcomes included the prevalence of etiologial diagnosis, the clinical response and seven-day and 30-day mortality rates.</p> Results <p>During the study period, 657 patients were enrolled, 135 in the AMS and 522 in the non-AMS group, with a median age of 71&#xa0;years (IQR 58–79). Patients in the AMS group had a more severe disease with a higher rate of sepsis or septic shock at admission (<i>p</i> &lt; 0.001). In the AMS group, the percentage of patients with a microbiological diagnosis was higher (67% vs 43.1% <i>p</i> &lt; 0.001); regarding empirical antibiotic therapy, drugs of the Access class were more frequently prescribed as empirical treatment in the AMS group (48.3 vs 37%, <i>p</i> = 0.04). No statistically significant differences were observed in terms of 7- and 30-day mortality and 7-day clinical response between the 2 groups, despite the higher severity of patients in the AMS group.</p> Conclusions <p>In the centre where an AMS program was conducted, an increase in the number of positive urine cultures (67% vs 43.1%) has been observed, and a higher rate of prescriptions for Access class antibiotics. Further prospective data are needed to evaluate the impact of AMS intervention on antimicrobial prescribing in emergency setting.</p>

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Impact of a persuasive antimicrobial stewardship program on antibiotic use in patients admitted to emergency department for urinary tract infections: a multicentre prospective study

  • 期刊论文

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  • 发表日期：

    2025年11月22日

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  • Margherita Macera,
  • Annabella Salvati,
  • Enrico Allegorico,
  • Caterina Monari,
  • Monica Vanni,
  • Marina D’Isanto,
  • Nicoletta Vitelli,
  • Francesca Delgado,
  • Carmine Nasta,
  • Adelaide Mariniello,
  • Filomena Fabozzi,
  • Raffaella Coppola,
  • Fabio Giuliano Numis,
  • Giovanna Guiotto,
  • Mauro Giordano,
  • Rosa Raucci,
  • Ferdinando Dello Vicario,
  • Rodolfo Nasti,
  • Lorenzo Onorato,
  • Nicola Coppola,
  • Ilaria De Luca,
  • Alessandro Cornelli,
  • Piero Bianco,
  • Stefano Aiello,
  • Antonio Carannante,
  • Nicola Compagnone,
  • Carmen Rapuano,
  • Biagio Migliaccio,
  • Romeo Morelli,
  • Francesca Palumbo,
  • Alfredo Palumbo,
  • Maria Teresa Florio,
  • Anna Amato,
  • Anna Santagata,
  • Nicola Quaranta,
  • Vincenza Serrao,
  • Augusto Delle Femine,
  • Ilaria Guida,
  • Annalisa Amelia,
  • Federica Miglietta,
  • Roberta Sciorio,
  • Kim Russo,
  • Federica Esposito,
  • Luca De Capua,
  • Gennaro Maria Borrelli,
  • Rosa Giamattei

摘要

Background

The spread of antibiotic resistance makes it necessary to implement Antimicrobial Stewardship (AMS) Programs; the aim of this study is to evaluate the impact of an AMS program in the management of urinary tract infection (UTI) in emergency setting.

Methods

A prospective multicentre study was conducted enrolling all adult patients admitted to one of the 8 emergency departments participating in the study with a diagnosis of UTI from February 2023 to July 2024. Only one of the eight centers received a persuasive AMS program. The primary outcome evaluated was the prevalence of empirical antimicrobial prescription belonging to Access class according to WHO classification in AMS and non-AMS ED; secondary outcomes included the prevalence of etiologial diagnosis, the clinical response and seven-day and 30-day mortality rates.

Results

During the study period, 657 patients were enrolled, 135 in the AMS and 522 in the non-AMS group, with a median age of 71 years (IQR 58–79). Patients in the AMS group had a more severe disease with a higher rate of sepsis or septic shock at admission (p < 0.001). In the AMS group, the percentage of patients with a microbiological diagnosis was higher (67% vs 43.1% p < 0.001); regarding empirical antibiotic therapy, drugs of the Access class were more frequently prescribed as empirical treatment in the AMS group (48.3 vs 37%, p = 0.04). No statistically significant differences were observed in terms of 7- and 30-day mortality and 7-day clinical response between the 2 groups, despite the higher severity of patients in the AMS group.

Conclusions

In the centre where an AMS program was conducted, an increase in the number of positive urine cultures (67% vs 43.1%) has been observed, and a higher rate of prescriptions for Access class antibiotics. Further prospective data are needed to evaluate the impact of AMS intervention on antimicrobial prescribing in emergency setting.