Background and Importance Urinary Tract Infections (UTIs) are common bacterial infections with non-negligible hospitalisation rate. The diagnosis of UTIs remains a challenge for prescribers and common source for misdiagnosis.

Aim and Objectives This retrospective observational study aimed to evaluate whether recorded diagnosis by clinicians and empirical antibiotic therapy met the European Association of Urology (EAU) guideline in patients hospitalised with a UTI.

Material and Methods The study was conducted at an internal medicine unit of a tertiary care medical centre in Hungary. Diagnosis was assessed based on the clinical presentation, physical examination, and laboratory (inclusive microbiological) results considering risk factors. Diagnosis was considered misdiagnosis when was not confirmed by clinical presentation or clinical signs and symptoms. Analyses for empirical antibiotic therapy were performed only for confirmed UTIs. Empirical treatment was considered guideline adherent when complying with the recommendations. Fisher’s exact test and t-test were applied to compare categorical and continuous variables between groups. Significant p values were defined as below 0.05.

Results Out of 185 patients 41.6% (n=77) have not met EAU diagnosis criteria, of which 27.6% (n=51) were misdiagnosis and 14.1% (n=26) were ABU (asymptomatic bacteriuria). The diagnosis of urosepsis recorded at admission (9.7%) was not supported in any cases neither by clinical nor by microbiological tests. The initial empirical therapies for UTI showed a relatively low rate (45.4%, 49/108) of guideline adherence regarding to agent selection. The most common guideline non-adherent therapies were combinations with metronidazole (16,7%, 18/108). Although dosage appropriateness assessments showed a higher guideline adherence rate (36.1%, 39/108), underdosing due to the higher body weight was relatively high (9.3%, 10/108). Overall (agent, route of administration, dose, duration) guideline adherence was found to be substantially low (10.2%, 11/108).

Conclusion and Relevance We found a relatively high rate of misdiagnosed UTIs. Written protocols on the ward may be crucial in reducing misdiagnosis and in optimising antibiotic use.

Conflict of Interest No conflict of interest.