PDF(Pubmed)
Abstract：
UTIs (urinary tract infections) are common bacterial infections with a non-negligible hospitalization rate. The diagnosis of UTIs remains a challenge for prescribers and a common source of misdiagnosis. This retrospective observational study aimed to evaluate whether recorded diagnosis by clinicians and empirical antibiotic therapy met the EAU (European Association of Urology) guideline in patients hospitalized with UTI. The study was conducted at an internal medicine unit of a tertiary care medical center in Hungary. The diagnosis was assessed based on clinical presentation, physical examination, and laboratory (including microbiological) results, considering all the potential risk factors. Diagnosis was considered misdiagnosis when not confirmed by clinical presentation or clinical signs and symptoms. Evaluation of empirical antibiotic therapy was performed only for confirmed UTIs. Empirical treatment was considered guideline-adherent when complying with the relevant recommendations. Out of 185 patients, 41.6% failed to meet EAU-based UTI diagnosis criteria, of which 27.6% were misdiagnosed and 14.1% were ABU (asymptomatic bacteriuria). The diagnosis of urosepsis recorded at admission (9.7%, 18/185) was not confirmed either by clinical or microbiological tests in five (5/18) cases. The initial empirical therapies for UTI showed a relatively low rate (45.4%) of guideline adherence regarding agent selection. The most common guideline-non-adherent therapies were combinations with metronidazole (16.7%). Dosage appropriateness assessments showed a guideline adherence rate of 36.1%, and underdosing due to high body weight was common (9.3%). Overall (agent, route of administration, dose, duration) guideline adherence was found to be substantially low (10.2%). We found a relatively high rate of misdiagnosed UTIs. Written protocols on the ward may be crucial in reducing misdiagnosis and in optimizing antibiotic use.
摘要：
尿路感染（尿路感染）是常见的细菌感染，住院率不可忽视。UTI的诊断仍然是处方者的挑战和误诊的常见来源。这项回顾性观察性研究旨在评估UTI住院患者的临床医生记录诊断和经验性抗生素治疗是否符合EAU（欧洲泌尿外科协会）指南。该研究是在匈牙利三级医疗中心的内科部门进行的。根据临床表现评估诊断，体检,和实验室（包括微生物）结果，考虑到所有潜在的风险因素。当临床表现或临床体征和症状未证实时，诊断被认为是误诊。经验性抗生素治疗的评估仅针对经证实的UTI进行。在遵守相关建议时，经验治疗被认为是遵循指南的。185名患者中,41.6%不符合基于EAU的UTI诊断标准，其中27.6%被误诊,14.1%为ABU(无症状性菌尿)。入院时记录的尿脓毒症诊断（9.7％，18/185）在5例（5/18）病例中没有通过临床或微生物学测试得到证实。UTI的初始经验疗法显示出相对较低的药物选择指南依从性（45.4％）。最常见的指南非依附性治疗是与甲硝唑的组合（16.7％）。剂量适当性评估显示，指南依从率为36.1%，由于高体重导致的给药不足是常见的(9.3%).总体(代理人，给药途径,剂量,持续时间)发现指南依从性相当低(10.2%)。我们发现UTI的误诊率相对较高。病房的书面协议对于减少误诊和优化抗生素使用可能至关重要。
