Failure to implement hospital antimicrobial prescribing guidelines: experience in another UK academic centre

Sir, Ali et al. recently reported poor compliance with prescribing guidelines for the treatment of community-acquired pneumonia and urinary tract infection (UTI) in two UK academic hospital groups. We would like to report the results of a prospective audit of the management of UTI in our Trust, which is also an academic centre. The aim of the audit was to determine whether physicians were managing UTIs in adult inpatients according to the Trust guideline. The guideline set out criteria for allocation of patients into clinical categories (uncomplicated/complicated UTI), and advised on the interpretation of the point of care testing (POCT), when to send a sample for culture, and choice and duration of empirical antibiotic therapy based on the local epidemiology of antibiotic resistance in Escherichia coli. It was written by microbiologists, infectious disease physicians and pharmacists. It was approved by the Trust’s Medicines Advisory Committee, and had been distributed in paper format to all Consultants about a year before the audit. It was available to all staff in electronic format via the hospital intranet. Data were collected prospectively for 100 consecutive adult acute general medical patients with a clinical diagnosis (intention to treat) of UTI. These were identified by daily ward review by one of the authors and by monitoring urine samples sent to the laboratory for culture. Of 70 female and 30 male patients, 51 had community-acquired UTI (diagnosis made within 48 h of admission) and 49 were hospital acquired. Thirty-one patients had catheter-related UTI (18 female), 64 patients had complicated UTI and 36 had uncomplicated disease.