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. 2025 Nov 22.
doi: 10.1186/s13756-025-01653-z. Online ahead of print.

Impact of a persuasive antimicrobial stewardship program on antibiotic use in patients admitted to emergency department for urinary tract infections: a multicentre prospective study

Margherita Macera  1 , Annabella Salvati  1 , Enrico Allegorico  2 , Caterina Monari  1 , Monica Vanni  2 , Marina D'Isanto  2 , Nicoletta Vitelli  3 , Francesca Delgado  3 , Carmine Nasta  4   5 , Adelaide Mariniello  6 , Filomena Fabozzi  7 , Raffaella Coppola  8 , Fabio Giuliano Numis  2 , Giovanna Guiotto  3 , Mauro Giordano  4   5 , Rosa Raucci  6 , Ferdinando Dello Vicario  7 , Rodolfo Nasti  8 , Lorenzo Onorato  9 , Nicola Coppola  1 ; UTILY study group
Collaborators, Affiliations
Free article

Impact of a persuasive antimicrobial stewardship program on antibiotic use in patients admitted to emergency department for urinary tract infections: a multicentre prospective study

Margherita Macera et al. Antimicrob Resist Infect Control. .
Free article

Abstract

Background: The spread of antibiotic resistance makes it necessary to implement Antimicrobial Stewardship (AMS) Programs; the aim of this study is to evaluate the impact of an AMS program in the management of urinary tract infection (UTI) in emergency setting.

Methods: A prospective multicentre study was conducted enrolling all adult patients admitted to one of the 8 emergency departments participating in the study with a diagnosis of UTI from February 2023 to July 2024. Only one of the eight centers received a persuasive AMS program. The primary outcome evaluated was the prevalence of empirical antimicrobial prescription belonging to Access class according to WHO classification in AMS and non-AMS ED; secondary outcomes included the prevalence of etiologial diagnosis, the clinical response and seven-day and 30-day mortality rates.

Results: During the study period, 657 patients were enrolled, 135 in the AMS and 522 in the non-AMS group, with a median age of 71 years (IQR 58-79). Patients in the AMS group had a more severe disease with a higher rate of sepsis or septic shock at admission (p < 0.001). In the AMS group, the percentage of patients with a microbiological diagnosis was higher (67% vs 43.1% p < 0.001); regarding empirical antibiotic therapy, drugs of the Access class were more frequently prescribed as empirical treatment in the AMS group (48.3 vs 37%, p = 0.04). No statistically significant differences were observed in terms of 7- and 30-day mortality and 7-day clinical response between the 2 groups, despite the higher severity of patients in the AMS group.

Conclusions: In the centre where an AMS program was conducted, an increase in the number of positive urine cultures (67% vs 43.1%) has been observed, and a higher rate of prescriptions for Access class antibiotics. Further prospective data are needed to evaluate the impact of AMS intervention on antimicrobial prescribing in emergency setting.

Keywords: Antimicrobial stewardship; Emergency Department; Empirical treatment; UTI; Urinary tract infections.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Ethics Committee of the University of Campania Luigi Vanvitelli, Naples (n◦ 35093/2023). Competing interests: The authors declare no competing interests.

References

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