Résumé
The escalating risk of bacterial resistance necessitates the stringent utilization of antibiotics. Upper urinary tract infections (UTI) are a recurring reason for emergency department consultations, with clear French national recommendations from the SPILF dating back to 2018. De-escalation of empirical antibiotic therapy is always recommended when possible in favor of a narrower-spectrum antibiotic to reduce the risk of selecting resistant species. Objective: the objective was to analyze the prevalence of outpatient de-escalation of empirical antibiotic therapies initiated in the emergency department for an upper UTI following the transmission of the antibiogram to the patient and/or their primary care physician.Methods: this was a single-center, observational, historical-prospective study conducted between December 30, 2022, and June 30, 2023, at the Montpellier University Hospital emergency department. Patient records of those managed on an outpatient basis for an upper UTI with a positive urine culture and empirical antibiotic therapy upon discharge were examined. Treating physicians or patients were contacted 14 days after their emergency department consultation to ascertain the continuation of antibiotic treatment. In cases where therapeutic adjustments were made, changes in the drug (molecule), dosage, and duration were recorded and compared to national recommendations to assess their appropriateness.Results: among the 119 included patients, 72 (60%) were eligible for outpatient antibiotic de-escalation by their treating physician. 14 (20%) of them received de-escalation in accordance with national recommendations. 45% of empirical antibiotics initiated in the emergency department were not in line with national recommendations, either in terms of the drug or treatment duration chosen.A significant proportion of penicillin resistance was found in Escherichia coli bacteria, with 55% of strains resistant to amoxicillin and 35% resistant to amoxicillin in combination with clavulanic acid. Discussion–conclusion: de-escalation of antibiotic therapies in upper UTI is insufficient in the in the outpatient patient management, and improvement of practices in the emergency department regarding empiricalantibiotic therapies is necessary to reduce the selective pressure on antibiotic-resistant bacteria.