Antibiotic prescribing appropriateness for urinary tract infections in a tertiary emergency department: a retrospective cohort study
Abstract
Antibiotic misuse in emergency departments (EDs) drives antimicrobial resistance and adverse outcomes. This study assessed ED antibiotic prescribing adherence to hospital UTI guidelines at King Abdulaziz Medical City, Jeddah, Saudi Arabia, and identified predictors of non-adherence.
This retrospective cohort study included consecutive patients undergoing urine culture in the ED between September and December 2021. Two independent clinical pharmacists assessed appropriateness using the validated National Antimicrobial Prescribing Survey (NAPS) tool against the Ministry of National Guard Health Affairs (MNGHA) 2022 UTI guidelines across four domains: drug selection, dose, route, and duration. Two binary logistic regression models identified independent predictors of non-adherence and 30-day ED revisit.
Of 346 patients (78.0% female), 184 (53.2%) had positive cultures and 216 (62.4%) received antibiotics. Overall, 153 (44.2%) had guideline-adherent management and 189 (54.6%) were non-adherent; among antibiotic-treated patients, only 31 (14.4%) received a guideline-adherent prescription. Leading non-adherence reasons were inappropriate drug selection (31.7%), overtreatment (29.6%), and resistance mismatch (13.8%). Positive culture (adjusted OR 1.89,
p
= 0.018) and UTI indication (adjusted OR 2.79,
p
< 0.001) independently predicted non-adherence. Positive-culture patients had higher 30-day ED revisit rates (26.6% vs. 14.8%,
p
= 0.008). Independent predictors of revisit were…
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