评估黎巴嫩医院尿路感染治疗国家指南的依从性：一项多中心横断面研究

IF 2.3 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health Pub Date : 2025-04-11 DOI:10.1016/j.cegh.2025.102032

Deema Rahme , Hania Nakkash Chmaisse , Rabih Hallit , Pascale Salameh

{"title":"评估黎巴嫩医院尿路感染治疗国家指南的依从性：一项多中心横断面研究","authors":"Deema Rahme , Hania Nakkash Chmaisse , Rabih Hallit , Pascale Salameh","doi":"10.1016/j.cegh.2025.102032","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Inappropriate antibiotic prescribing for urinary tract infections (UTIs) is a major issue in Lebanon, leading to increased antimicrobial resistance (AMR). This study assesses antibiotic-prescribing practices and evaluates physicians' adherence to national guidelines for UTI management in hospitalized patients, while also identifying factors linked to inappropriate prescribing.</div></div><div><h3>Methods</h3><div>This cross-sectional study was conducted in five university hospitals across Lebanon from March 2022 to December 2023. Prescribed antibiotics were compared against the Lebanese national guidelines for UTIs. Data analysis utilized IBM SPSS® version 27, incorporating descriptive statistics, bivariate analysis, and multivariable logistic regression, with significance set at p ≤ 0.05.</div></div><div><h3>Results</h3><div>The study included 401 patients (61.8 % females), with a mean age of 64.81 years. Appropriate antibiotic prescribing occurred in 52.4 % of cases, highest in complicated pyelonephritis (62.3 %) and lowest in uncomplicated pyelonephritis (38.7 %). Bivariate analysis linked older age (p = 0.042), flank pain (p < 0.001), nausea/vomiting (p = 0.001), and frequency/urgency (p = 0.007) to appropriate treatment. Physician position significantly impacted adherence (consultants: 81.8 % vs. residents: 32.4 %, p < 0.001). Multivariable analysis showed that carbapenems (OR: 1.76, p = 0.032) and fluoroquinolones (OR: 9.49, p < 0.001) were associated with inappropriate prescribing.</div></div><div><h3>Conclusions</h3><div>The study reveals widespread non-compliance with UTI treatment guidelines in Lebanon, leading to inappropriate antibiotic use and AMR. It is recommended that educational programs, prescribing audits, and improved residency training be implemented. Reinforcement of Antimicrobial Stewardship Programs, the use of clinical decision support tools, and the enhancement of regulatory frameworks are key steps to improve guideline adherence and combat <span>AMR</span>.</div></div>","PeriodicalId":46404,"journal":{"name":"Clinical Epidemiology and Global Health","volume":"33 ","pages":"Article 102032"},"PeriodicalIF":2.3000,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Evaluating Compliance with National Guidelines for Urinary Tract Infection Treatment in Lebanese Hospitals: A Multicenter Cross-Sectional Study\",\"authors\":\"Deema Rahme , Hania Nakkash Chmaisse , Rabih Hallit , Pascale Salameh\",\"doi\":\"10.1016/j.cegh.2025.102032\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>Inappropriate antibiotic prescribing for urinary tract infections (UTIs) is a major issue in Lebanon, leading to increased antimicrobial resistance (AMR). This study assesses antibiotic-prescribing practices and evaluates physicians' adherence to national guidelines for UTI management in hospitalized patients, while also identifying factors linked to inappropriate prescribing.</div></div><div><h3>Methods</h3><div>This cross-sectional study was conducted in five university hospitals across Lebanon from March 2022 to December 2023. Prescribed antibiotics were compared against the Lebanese national guidelines for UTIs. Data analysis utilized IBM SPSS® version 27, incorporating descriptive statistics, bivariate analysis, and multivariable logistic regression, with significance set at p ≤ 0.05.</div></div><div><h3>Results</h3><div>The study included 401 patients (61.8 % females), with a mean age of 64.81 years. Appropriate antibiotic prescribing occurred in 52.4 % of cases, highest in complicated pyelonephritis (62.3 %) and lowest in uncomplicated pyelonephritis (38.7 %). Bivariate analysis linked older age (p = 0.042), flank pain (p < 0.001), nausea/vomiting (p = 0.001), and frequency/urgency (p = 0.007) to appropriate treatment. Physician position significantly impacted adherence (consultants: 81.8 % vs. residents: 32.4 %, p < 0.001). Multivariable analysis showed that carbapenems (OR: 1.76, p = 0.032) and fluoroquinolones (OR: 9.49, p < 0.001) were associated with inappropriate prescribing.</div></div><div><h3>Conclusions</h3><div>The study reveals widespread non-compliance with UTI treatment guidelines in Lebanon, leading to inappropriate antibiotic use and AMR. It is recommended that educational programs, prescribing audits, and improved residency training be implemented. Reinforcement of Antimicrobial Stewardship Programs, the use of clinical decision support tools, and the enhancement of regulatory frameworks are key steps to improve guideline adherence and combat <span>AMR</span>.</div></div>\",\"PeriodicalId\":46404,\"journal\":{\"name\":\"Clinical Epidemiology and Global Health\",\"volume\":\"33 \",\"pages\":\"Article 102032\"},\"PeriodicalIF\":2.3000,\"publicationDate\":\"2025-04-11\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Clinical Epidemiology and Global Health\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2213398425001216\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Epidemiology and Global Health","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2213398425001216","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH","Score":null,"Total":0}

引用次数: 0

摘要

尿路感染（uti）的适当抗生素处方是黎巴嫩的一个主要问题，导致抗菌素耐药性（AMR）增加。本研究评估了抗生素处方实践，并评估了医生对住院患者尿路感染管理国家指南的遵守情况，同时也确定了与不当处方相关的因素。方法本横断面研究于2022年3月至2023年12月在黎巴嫩五所大学医院进行。将处方抗生素与黎巴嫩国家尿路感染指南进行比较。数据分析采用IBM SPSS®version 27，采用描述性统计、双变量分析和多变量logistic回归，显著性p≤0.05。结果共纳入401例患者，其中女性61.8%，平均年龄64.81岁。合理使用抗生素的病例占52.4%，其中复杂性肾盂肾炎最高（62.3%），非复杂性肾盂肾炎最低（38.7%）。双变量分析将老年（p = 0.042）、侧腹疼痛(p <；0.001)、恶心/呕吐（p = 0.001）和频繁/急迫（p = 0.007）需要适当治疗。医师职位显著影响依从性(顾问：81.8% vs.住院医师：32.4%,p <；0.001)。多变量分析显示碳青霉烯类药物（OR: 1.76, p = 0.032）和氟喹诺酮类药物(OR: 9.49, p <；0.001)与处方不当有关。该研究表明，黎巴嫩普遍不遵守尿路感染治疗指南，导致抗生素使用不当和抗生素耐药性。建议实施教育计划、处方审计和改进住院医师培训。加强抗微生物药物管理规划、使用临床决策支持工具和加强监管框架是提高指南依从性和抗击抗生素耐药性的关键步骤。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

Evaluating Compliance with National Guidelines for Urinary Tract Infection Treatment in Lebanese Hospitals: A Multicenter Cross-Sectional Study

Background

Inappropriate antibiotic prescribing for urinary tract infections (UTIs) is a major issue in Lebanon, leading to increased antimicrobial resistance (AMR). This study assesses antibiotic-prescribing practices and evaluates physicians' adherence to national guidelines for UTI management in hospitalized patients, while also identifying factors linked to inappropriate prescribing.

Methods

This cross-sectional study was conducted in five university hospitals across Lebanon from March 2022 to December 2023. Prescribed antibiotics were compared against the Lebanese national guidelines for UTIs. Data analysis utilized IBM SPSS® version 27, incorporating descriptive statistics, bivariate analysis, and multivariable logistic regression, with significance set at p ≤ 0.05.

Results

The study included 401 patients (61.8 % females), with a mean age of 64.81 years. Appropriate antibiotic prescribing occurred in 52.4 % of cases, highest in complicated pyelonephritis (62.3 %) and lowest in uncomplicated pyelonephritis (38.7 %). Bivariate analysis linked older age (p = 0.042), flank pain (p < 0.001), nausea/vomiting (p = 0.001), and frequency/urgency (p = 0.007) to appropriate treatment. Physician position significantly impacted adherence (consultants: 81.8 % vs. residents: 32.4 %, p < 0.001). Multivariable analysis showed that carbapenems (OR: 1.76, p = 0.032) and fluoroquinolones (OR: 9.49, p < 0.001) were associated with inappropriate prescribing.

Conclusions

The study reveals widespread non-compliance with UTI treatment guidelines in Lebanon, leading to inappropriate antibiotic use and AMR. It is recommended that educational programs, prescribing audits, and improved residency training be implemented. Reinforcement of Antimicrobial Stewardship Programs, the use of clinical decision support tools, and the enhancement of regulatory frameworks are key steps to improve guideline adherence and combat AMR.

求助全文

通过发布文献求助，成功后即可免费获取论文全文。去求助

来源期刊

Clinical Epidemiology and Global Health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-

CiteScore

4.60

自引率

7.70%

发文量

218

审稿时长

66 days

期刊介绍： Clinical Epidemiology and Global Health (CEGH) is a multidisciplinary journal and it is published four times (March, June, September, December) a year. The mandate of CEGH is to promote articles on clinical epidemiology with focus on developing countries in the context of global health. We also accept articles from other countries. It publishes original research work across all disciplines of medicine and allied sciences, related to clinical epidemiology and global health. The journal publishes Original articles, Review articles, Evidence Summaries, Letters to the Editor. All articles published in CEGH are peer-reviewed and published online for immediate access and citation.