Abstract：
OBJECTIVE: A simplified therapeutic guideline (STG) was established in our urology ward in 2019 for urinary infections. Our aim was to describe the level of physician adherence to STG and the impact of a limited number of antibiotic compounds on the rate of multidrug-resistant (MDR) bacteria. As guidelines should improve patient care, unfavorable outcomes were also reported.
METHODS: The STG for community-acquired and nosocomial urinary infections, including six antibiotics, was established in November 2019 and has been officially applied since January 2020. Treatment duration has to be ≤14 days. We conducted a before-after study to measure physician adherence to the STG for bacteremia treatment between January 2017 and December 2022. Adherence was defined as exclusive use of STG antibiotics. All isolated bacteria from blood cultures were recorded, including MDR Enterobacterales, defined as AmpC β-lactamase- or ESBL-producing strains. Unfavorable outcomes were defined as uncontrolled infection, a second surgical procedure, ICU requirement, and/or death.
RESULTS: Seventy-six cases of bacteremia occurred between January 2017 and December 2019, and ninety between January 2020 and December 2022. The main comorbid condition was urological cancer (46%). The main reason for surgery was ureteral stent (32%). Antibiotic management in accordance with STG increased from 18% to 52%, p < 0.001, and treatments > 14 days decreased from 53% to 28%, p < 0.001. MDR Enterobacterales bacteremia was reduced from 52% to 35%, p = 0.027. The rate of unfavorable outcomes was unchanged.
CONCLUSIONS: STG adherence in urology was satisfactory and associated with reduced MDR Enterobacterales bacteremia.
METHODS: The STG for community-acquired and nosocomial urinary infections, including six antibiotics, was established in November 2019 and has been officially applied since January 2020. Treatment duration has to be ≤14 days. We conducted a before-after study to measure physician adherence to the STG for bacteremia treatment between January 2017 and December 2022. Adherence was defined as exclusive use of STG antibiotics. All isolated bacteria from blood cultures were recorded, including MDR Enterobacterales, defined as AmpC β-lactamase- or ESBL-producing strains. Unfavorable outcomes were defined as uncontrolled infection, a second surgical procedure, ICU requirement, and/or death.
RESULTS: Seventy-six cases of bacteremia occurred between January 2017 and December 2019, and ninety between January 2020 and December 2022. The main comorbid condition was urological cancer (46%). The main reason for surgery was ureteral stent (32%). Antibiotic management in accordance with STG increased from 18% to 52%, p < 0.001, and treatments > 14 days decreased from 53% to 28%, p < 0.001. MDR Enterobacterales bacteremia was reduced from 52% to 35%, p = 0.027. The rate of unfavorable outcomes was unchanged.
CONCLUSIONS: STG adherence in urology was satisfactory and associated with reduced MDR Enterobacterales bacteremia.
摘要：
目的：2019年在泌尿外科病房建立了简化治疗指南（STG）。我们的目的是描述医生对STG的依从性水平以及有限数量的抗生素化合物对多药耐药（MDR）细菌比率的影响。由于指南应该改善患者护理，也报告了不利的结果.
方法：STG用于社区获得性和医院泌尿系感染，包括六种抗生素，成立于2019年11月，自2020年1月起正式申请。治疗时间必须≤14天。我们在2017年1月至2022年12月之间进行了一项前后研究，以测量医生对STG治疗菌血症的依从性。坚持被定义为仅使用STG抗生素。记录所有从血液培养物中分离的细菌，包括MDR肠杆菌，定义为产生AmpCβ-内酰胺酶或ESBL的菌株。不利的结果被定义为不受控制的感染，第二次外科手术,ICU要求,和/或死亡。
结果：在2017年1月至2019年12月期间发生了76例菌血症，在2020年1月至2022年12月期间发生了90例。主要合并症是泌尿系癌症（46％）。手术的主要原因是输尿管支架(32%)。根据STG的抗生素管理从18％增加到52％，p<0.001，治疗>14天从53%下降到28%，p<0.001。MDR肠杆菌菌血症从52%降低到35%，p=0.027。不利结果的比率没有变化。
结论：STG在泌尿外科中的依从性是令人满意的，并且与减少MDR肠杆菌菌血症相关。
方法：STG用于社区获得性和医院泌尿系感染，包括六种抗生素，成立于2019年11月，自2020年1月起正式申请。治疗时间必须≤14天。我们在2017年1月至2022年12月之间进行了一项前后研究，以测量医生对STG治疗菌血症的依从性。坚持被定义为仅使用STG抗生素。记录所有从血液培养物中分离的细菌，包括MDR肠杆菌，定义为产生AmpCβ-内酰胺酶或ESBL的菌株。不利的结果被定义为不受控制的感染，第二次外科手术,ICU要求,和/或死亡。
结果：在2017年1月至2019年12月期间发生了76例菌血症，在2020年1月至2022年12月期间发生了90例。主要合并症是泌尿系癌症（46％）。手术的主要原因是输尿管支架(32%)。根据STG的抗生素管理从18％增加到52％，p<0.001，治疗>14天从53%下降到28%，p<0.001。MDR肠杆菌菌血症从52%降低到35%，p=0.027。不利结果的比率没有变化。
结论：STG在泌尿外科中的依从性是令人满意的，并且与减少MDR肠杆菌菌血症相关。
