Antibiotikaverschreibung in urologischen Kliniken Deutschlands: Ergebnisse einer Querschnittstudie

Die Urologie, vol. 64, pp. 165–172

Abstract

BACKGROUND: The patterns and intensity of inpatient antibiotic prescribing vary according to medical specialty. OBJECTIVES: Analysis of recent data on antibiotic use density in hospital departments of urology in Germany. METHODS: Annual surveillance data of 107 departments for the period 2022/2023 were evaluated. We used a daily dose definition adapted for adult hospitalized patients (recommended daily doses, RDD), and 100 patient days as the denominator (RDD/100). RESULTS: The overall median antibiotic use density was 71 RDD/100 with a wide range between 15.9 and 138.7 RDD/100 but no significant differences according to hospital size. Fluoroquinolones (median 6.0 RDD/100) were prescribed as the fourth most frequent antibiotic class after broad-spectrum cephalosporins (median 16.2 RDD/100), aminopenicillin/beta-lactamase inhibitor combinations (median 10.8 RDD/100), and broad-spectrum penicillins (piperacillin-tazobactam and piperacillin) (median 8.9 RDD/100). The ratio between penicillin and cephalosporin RDD per hospital ranged from 6:94 to 98:2 (overall 52:48). The proportion of aminoglycosides (< 1%) and parenteral fosfomycin (< 0.1%) was very small. Cotrimoxazole (median 4.0 RDD/100) was less frequently prescribed than fluoroquinolones. The proportion of oral agents was 44.7% overall, with only small differences according to hospital size. Oral fosfomycin, pivmecillinam, nitrofurantoin, and nitroxoline were much less frequently prescribed than oral beta-lactams, fluoroquinolones, and cotrimoxazole. CONCLUSION: The overall antibiotic use density in urological hospital departments varied substantially in 2022/2023. Beta-lactam antibiotics were the most frequently used antibiotics, while fluoroquinolones (often as oral agents) continued to be prescribed with a large range similar to overall antibiotic use and independent of hospital size. Inpatient prescribing of the agents recommended and typically used for uncomplicated cystitis was rare. Penicillins and cotrimoxazole should more often be considered as the treatment option. Aminoglycosides and parenteral fosfomycin should be discussed in cases of otherwise drug-resistant pathogens.

Authors 7

1. Winfried V. Kern corresponding

   University of Freiburg · University Medical Center Freiburg

   Affiliation as printed

   Abteilung Infektiologie, Universitätsklinikum Freiburg, Hugstetter Straße 55, 79106, Freiburg, Deutschland. winfried.kern@uniklinik-freiburg.de

   Akademie für Infektionsmedizin e. V., Berlin, Deutschland. winfried.kern@uniklinik-freiburg.de

   Klinik für Innere Medizin II, Abteilung Infektiologie, Universitätsklinikum Freiburg, Freiburg, Deutschland. winfried.kern@uniklinik-freiburg.de

   Medizinische Fakultät, Universität Freiburg, Freiburg, Deutschland. winfried.kern@uniklinik-freiburg.de

   Klinik für Innere Medizin II, Abteilung Infektiologie, Universitätsklinikum Freiburg, Freiburg, Deutschland

2. Gesche Först

   University of Freiburg · University Medical Center Freiburg

   Affiliation as printed

   Institut für Pharmazeutische Wissenschaften, Universität Freiburg, Freiburg, Deutschland

   Klinik für Innere Medizin II, Abteilung Infektiologie, Universitätsklinikum Freiburg, Freiburg, Deutschland

3. Evelyn Kramme

   University Hospital Schleswig-Holstein

   Affiliation as printed

   Klinik für Infektiologie, Universitätsklinikum Schleswig-Holstein Campus Lübeck, Lübeck, Deutschland

4. Michaela Steib–Bauert

   University of Freiburg · University Medical Center Freiburg

   Affiliation as printed

   Klinik für Innere Medizin II, Abteilung Infektiologie, Universitätsklinikum Freiburg, Freiburg, Deutschland

5. Jennifer Kranz Aachen Klinik für Urologie und Kinderurologie

   Universitätsklinikum Aachen · University Hospital in Halle

   Affiliation as printed

   Klinik für Urologie und Kinderurologie, Uniklinik RWTH Aachen, Aachen, Deutschland

   Klinik und Poliklinik für Urologie, Universitätsklinikum Halle (Saale), Halle (Saale), Deutschland

6. Giuseppe Magistro

   Asklepios · Asklepios Kliniken Hamburg

   Affiliation as printed

   Klinik für Urologie, Asklepios Westklinikum GmbH, Hamburg, Deutschland

7. Katja de With

   Technische Universität Dresden · University Hospital Carl Gustav Carus

   Affiliation as printed

   Institut für Klinische Infektiologie, Universitätsklinikum Carl Gustav Carus an der TU Dresden, Dresden, Deutschland