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Adequacy of an evidence-based treatment guideline for complicated urinary tract infections in the Netherlands and the effectiveness of guideline adherence

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Abstract

Guideline recommendations on empirical antibiotic treatment are based on the literature, expert opinion, expected pathogens and resistance data, but their adequacy in the real-life setting is often unknown. We investigated the adequacy of the Dutch evidence-based guideline-recommended treatment options for patients with complicated urinary tract infections (UTIs) 2 years after guideline publication and, additionally, the adequacy of actually prescribed empirical therapy for patients treated with guideline-adherent versus non-guideline-adherent therapy. A retrospective, observational multicentre study in the Netherlands included 810 patients with a complicated UTI without special conditions and 174 with a urinary catheter. The susceptibility patterns of cultured uropathogens were compared with guideline-recommended treatment options, which included specific recommendations for patients with a catheter, and with actually prescribed empirical therapy. We considered inadequate coverage rates below 10 % as acceptable. Of the recommended regimens for patients with a UTI without other conditions, only the guideline-recommended combination of amoxicillin–gentamicin was acceptable (inadequate coverage rate 6 %). For patients with a catheter, inadequate coverage rates of recommended regimens ranged from 3 to 24 %. In patients with a UTI without other conditions, actually prescribed guideline-adherent therapy resulted in less broad-spectrum but not in less adequate therapy; in patients with a catheter, actually prescribed guideline-adherent therapy resulted in a higher coverage rate than those prescribed non-guideline-adherent therapy. Due to the continuously changing resistance rates and differences between the epidemiologies of uropathogens assumed in the guideline and those in real life, regular real-life assessments of recommended treatment options are necessary. Guideline adherence seems to be effective for increasing coverage rates without prescribing unnecessarily broad regimens.

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Acknowledgments

The authors thank all the medical specialists and staff of the participating hospitals: in the Urology departments, Th. M. de Reijke (Academic Medical Centre), M. Bekker (Antonius Hospital Sneek), R. Vleeming (BovenIJ Hospital), B. Meijer (Flevo Hospital), F. M. J. A. Froeling (Haga Hospital), J. H. van der Veen (Kennemer Hospital), S. D. Bos (Medical Centre Alkmaar), G. van Andel (Onze Lieve Vrouwe Hospital), P. C. Weijerman (Rijnstate Hospital), H. F. M. Karthaus (Canisius-Wilhelmina Hospital), A. Claessen (Rode Kruis Hospital), P. L. M. Vijverberg (St Antonius Hospital Nieuwegein), E. P. van Haarst (Sint Lucas Andreas Hospital), P. J. M. Kil (St Elisabeth Hospital), J. A. Witjes (Radboud University Nijmegen Medical Centre), M. T. W. T. Lock (University Medical Centre Utrecht), R. J. A. van Moorselaar (VU University Medical Center), Y. Reisman (Amstelland Hospital) and K. C. van Dalen (Diaconessen Hospital); and in the Internal Medicine departments, P. Speelman (Academic Medical Centre), G. J. Veldhuis (Antonius Hospital Sneek), M. G. W. Barnas (BovenIJ Hospital), J. Branger (Flevo Hospital), E. F. Schippers (Haga Hospital), R. Soetekouw (Kennemer Hospital), W. Bronsveld (Medical Centre Alkmaar), K. Brinkman (Onze Lieve Vrouwe Hospital), E. H. Gisolf (Rijnstate Hospital), A. S. M. Dofferhoff (Canisius-Wilhelmina Hospital), G. van Twillert (Rode Kruis Hospital), H. S. Biemond-Moeniralam (St Antonius Hospital Nieuwegein), J. Veenstra (Sint Lucas Andreas Hospital), M. E. E. van Kasteren (St Elisabeth Hospital), J. W. M. van der Meer (Radboud University Nijmegen Medical Centre), I. M. Hoepelman (University Medical Center Utrecht), M. A. van Agtmael (VU University Medical Center), L. A. Noach (Amstelland Hospital) and P. R. J. Gallas (Diaconessen Hospital). The authors also thank Prof. Dr. J.W. Mouton (Radboud University Nijmegen Medical Centre).

Funding

This work was supported by ZonMw, the Netherlands Organisation for Health Research and Development, project number 993002. The English language was checked by Laraine Visser-Isles (The Language Bureau).

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Internal Medicine, Division of Infectious Diseases, Centre for Infection and Immunity Amsterdam (CINIMA), Academic Medical Centre, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands

    V. Spoorenberg, J. M. Prins & S. E. Geerlings

  2. Department of Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre, P.O. Box 616, 6200 MD, Maastricht, The Netherlands

    E. E. Stobberingh

  3. Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands

    M. E. J. L. Hulscher

Authors
  1. V. Spoorenberg
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  2. J. M. Prins
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  3. E. E. Stobberingh
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  4. M. E. J. L. Hulscher
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  5. S. E. Geerlings
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Correspondence to V. Spoorenberg.

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Spoorenberg, V., Prins, J.M., Stobberingh, E.E. et al. Adequacy of an evidence-based treatment guideline for complicated urinary tract infections in the Netherlands and the effectiveness of guideline adherence. Eur J Clin Microbiol Infect Dis 32, 1545–1556 (2013). https://doi.org/10.1007/s10096-013-1909-6

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  • DOI: https://doi.org/10.1007/s10096-013-1909-6

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