Improving antibiotic use for complicated urinary tract infections

Guidelines for antimicrobial treatment are important in the process of improving antibiotic use, because they describe appropriate antibiotic use.
In this thesis, we demonstrated the value of appropriate antibiotic use (i.e. guideline adherence) in patients with a complicated urinary tract infection (UTI), one of the most prevalent infectious diseases in hospital. Appropriate antibiotic use increases bacterial coverage rates without prescribing unnecessarily broad regimens, which is beneficial for containment of bacterial resistance. Furthermore, appropriate antibiotic use seems to reduce length of hospital stay by more than 2 days and therefore favours patient outcome and health care costs.
In current practice, a large variation was shown between departments in the appropriateness of antibiotic use for patients with a complicated UTI. This was to some extent determined by patient characteristics, and only to a limited extent by department or hospital characteristics. No single antibiotic stewardship elements were consistently associated with appropriate antibiotic use.
We compared the effectiveness of two different strategies to improve the appropriateness antibiotic use in patients with a complicated UTI. We found that the effectiveness of both strategies was comparable and that better compliance with the strategies was associated with more improvement. Our study emphasize the need for a locally multidisciplinary team of engaged professionals to initiate improvement interventions, as recommended in antimicrobial stewardship programs.
Future improvement initiatives should aim to decrease inter-department variation in appropriateness of antibiotic use by focusing on departments with poor baseline performance, as low baseline performance was associated with a larger effect of improvement strategies.