ArticlePloS one2014
Effect of a stewardship intervention on adherence to uncomplicated cystitis and pyelonephritis guidelines in an emergency department setting.
Article in PloS one, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 47 papers, 2 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
47 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Artificial intelligence and machine learning applications in urinary tract infections identification and prediction: a systematic review and meta-analysis.World journal of urology · 2024Pooled it
- Antimicrobial stewardship programs in emergency departments: how do we measure antimicrobial use? A systematic review.Revista espanola de quimioterapia : publicacion oficial de la Sociedad Espanola de Quimioterapia · 2021Pooled it
- Outpatient management of urinary tract infections by medical officers in Nairobi, Kenya: lack of benefit from audit and feedback on adherence to treatment guidelines.BMC infectious diseases · 2023Trial
- Trial
- Urine Testing in Children with Viral Symptoms: A Nationwide Analysis of Ambulatory Visits, 2014-2019.The Journal of pediatrics · 2025Article
- Antimicrobial Stewardship in the Pediatric Emergency Department: An Observational Pre-Post Study.Children (Basel, Switzerland) · 2024Article
- Antibiotic Stewardship Interventions for Urinary Tract Infections in Outpatient Settings: A Narrative Review.Infectious disease clinics of North America · 2024Review
- What works for and what hinders deimplementation of low-value care in emergency medicine practice? A scoping review.BMJ open · 2023Article
- [Antimicrobial stewardship program in urinary tract infections due to multiresistant strains in the emergency department].Revista espanola de quimioterapia : publicacion oficial de la Sociedad Espanola de Quimioterapia · 2023Article
- Impact of a Multifaceted Intervention on Antibiotic Prescribing for Cystitis and Asymptomatic Bacteriuria in 23 Community Hospital Emergency Departments.Hospital pharmacy · 2023Article
- Young Women's Attitudes and Behaviors in Treatment and Prevention of UTIs: Are Biomedical Students at an Advantage?Antibiotics (Basel, Switzerland) · 2023Article
- Appropriateness of Empirical Prescriptions of Ceftriaxone and Identification of Opportunities for Stewardship Interventions: A Single-Centre Cross-Sectional Study.Antibiotics (Basel, Switzerland) · 2023Article
- An Approach to Improving Compliance of Treatment in Asymptomatic Bacteriuria.Spartan medical research journal · 2023Article
- Can Electronic Clinical Decision Support Systems Improve the Diagnosis of Urinary Tract Infections? A Systematic Review and Meta-Analysis.Open forum infectious diseases · 2023Article
- Assessment of the Compliance of Cystitis Management According to French Recommendations through the Analysis of Prescriptions Collected in Community Pharmacies.Antibiotics (Basel, Switzerland) · 2022Article
- The Five Ds of Outpatient Antibiotic Stewardship for Urinary Tract Infections.Clinical microbiology reviews · 2021Review
- Case-based audit and feedback around a decision aid improved antibiotic choice and duration for uncomplicated cystitis in primary care clinics.Family medicine and community health · 2021Article
- Changes in the management of urinary tract infections in women: impact of the new recommendations on antibiotic prescribing behavior in France, between 2014 and 2019.BMC health services research · 2021Article
- Decreased Overall and Inappropriate Antibiotic Prescribing in a Veterans Affairs Hospital Emergency Department following a Peer Comparison-Based Stewardship Intervention.Antimicrobial agents and chemotherapy · 2020Observational
- Asymptomatic Bacteriuria versus Symptom Underreporting in Older Emergency Department Patients with Suspected Urinary Tract Infection.Journal of the American Geriatrics Society · 2020Observational
Corrections and comments
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Authors and funding
9 authors.
Funding
Abstract
objectiveTo evaluate adherence to uncomplicated urinary tract infections (UTI) guidelines and UTI diagnostic accuracy in an emergency department (ED) setting before and after implementation of an antimicrobial stewardship intervention.
methodsThe intervention included implementation of an electronic UTI order set followed by a 2 month period of audit and feedback. For women age 18-65 with a UTI diagnosis seen in the ED with no structural or functional abnormalities of the urinary system, we evaluated adherence to guidelines, antimicrobial use, and diagnostic accuracy at baseline, after implementation of the order set (period 1), and after audit and feedback (period 2).
resultsAdherence to UTI guidelines increased from 44% (baseline) to 68% (period 1) to 82% (period 2) (P≤.015 for each successive period). Prescription of fluoroquinolones for uncomplicated cystitis decreased from 44% (baseline) to 14% (period 1) to 13% (period 2) (P<.001 and P = .7 for each successive period). Unnecessary antibiotic days for the 200 patients evaluated in each period decreased from 250 days to 119 days to 52 days (P<.001 for each successive period). For 40% to 42% of cases diagnosed as UTI by clinicians, the diagnosis was deemed unlikely or rejected with no difference between the baseline and intervention periods.
conclusionsA stewardship intervention including an electronic order set and audit and feedback was associated with increased adherence to uncomplicated UTI guidelines and reductions in unnecessary antibiotic therapy and fluoroquinolone therapy for cystitis. Many diagnoses were rejected or deemed unlikely, suggesting a need for studies to improve diagnostic accuracy for UTI.
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