Methods
Setting and population
Our study presents the baseline results of a cluster randomized
controlled trial testing a multifaceted stewardship
program to improve the appropriateness of antibiotic
use in patients with a complicated UTI in hospitals
(http://www.trialregister.nl; NTR1742).
Appropriateness of antibiotic use in patients with a
complicated UTI was assessed at the internal medicine
and urology departments of 19 university, teaching and
non-teaching hospitals located throughout the Netherlands.
Included were adult (≥16 years) inpatients/outpatients diagnosed
in 2008 by an internist or a urologist with a complicated
UTI as main diagnosis, and treated as such. We
defined a complicated UTI as a UTI with one (or more) of
the following characteristics: male gender, pregnancy, any
functional or anatomical abnormality of the urinary tract,
immunocompromising disease or medication, or a UTI
with symptoms of tissue invasion or systemic infection
[13]. The identification of patients as performed using the
national diagnosis registration system. Subsequent manual
screening took place, with the use of medical and nursing
records and admission sheets. A minimum number of 50
patients per department was included. If required to reach
a sufficient number also patients from 2007 were included.
Excluded were patient groups for whom the Dutch national
guideline does not provide a treatment recommendation
(i.e. patients with a nephrostomy) and patients who were
currently being treated for another infection or had been
transferred from or to another hospital.
The medical ethical committee of the Academic Medical
Centre Amsterdam considered our study and concluded
that it was deemed exempt from their approval
(ref 08.17.1775). No informed consent was obtained from
patients because no interventions at the patient level were
done and patient data were analysed in a retrospective
design anonymously, for the aim to improve quality
or healthcare.
Variables and data collection