{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T02:39:14Z","timestamp":1792636754888,"version":"4.5.0"},"reference-count":21,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T00:00:00Z","timestamp":1784937600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T00:00:00Z","timestamp":1792627200000},"content-version":"vor","delay-in-days":89,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Emerg Med"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Antibiotic misuse in emergency departments (EDs) drives antimicrobial resistance and adverse outcomes. This study assessed ED antibiotic prescribing adherence to hospital UTI guidelines at King Abdulaziz Medical City, Jeddah, Saudi Arabia, and identified predictors of non-adherence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective cohort study included consecutive patients undergoing urine culture in the ED between September and December 2021. Two independent clinical pharmacists assessed appropriateness using the validated National Antimicrobial Prescribing Survey (NAPS) tool against the Ministry of National Guard Health Affairs (MNGHA) 2022 UTI guidelines across four domains: drug selection, dose, route, and duration. Two binary logistic regression models identified independent predictors of non-adherence and 30-day ED revisit.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 346 patients (78.0% female), 184 (53.2%) had positive cultures and 216 (62.4%) received antibiotics. Overall, 153 (44.2%) had guideline-adherent management and 189 (54.6%) were non-adherent; among antibiotic-treated patients, only 31 (14.4%) received a guideline-adherent prescription. Leading non-adherence reasons were inappropriate drug selection (31.7%), overtreatment (29.6%), and resistance mismatch (13.8%). Positive culture (adjusted OR 1.89,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.018) and UTI indication (adjusted OR 2.79,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) independently predicted non-adherence. Positive-culture patients had higher 30-day ED revisit rates (26.6% vs. 14.8%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.008). Independent predictors of revisit were non-adherent prescribing (OR 2.20), pediatric age (OR 3.63), and prior antibiotic use (OR 2.91).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Antibiotic prescribing for UTIs in this tertiary ED demonstrated significant non-adherence to MNGHA guidelines, attributable primarily to inappropriate drug selection and overtreatment of culture-negative patients, and was independently associated with 30-day ED revisit. Electronic decision support, pharmacist-led culture follow-up, and local antibiogram updates are needed to improve prescribing quality. Addressing these gaps is an actionable priority for antimicrobial stewardship in resource-limited ED settings and is directly relevant to curbing antimicrobial resistance and improving patient safety. As a single-centre retrospective study restricted to culture-ordered patients, findings may not generalise to all ED UTI presentations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12873-026-01686-6","type":"journal-article","created":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T11:57:11Z","timestamp":1784980631000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Antibiotic prescribing appropriateness for urinary tract infections in a tertiary emergency department: a retrospective cohort study"],"prefix":"10.1186","volume":"26","author":[{"given":"Khulood","family":"Abdulghani","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maan","family":"Jamjoom","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaza Dheya","family":"Alothmany","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Razan Abdullah","family":"Filfilan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdullah Mohsen","family":"Alomairi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bsaim Abdulsalam","family":"Altirkistani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lama Hamoud","family":"Alsubhi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Faisal Fahad","family":"Aljadani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jamil M.","family":"Baljoon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sultan","family":"Alotaibi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,25]]},"reference":[{"issue":"17","key":"1686_CR1","doi-asserted-by":"publisher","first-page":"1864","DOI":"10.1001\/jama.2016.4151","volume":"315","author":"KE Fleming-Dutra","year":"2016","unstructured":"Fleming-Dutra KE, Hersh AL, Shapiro DJ, Bartoces M, Enns EA, File TM Jr, Finkelstein JA, Gerber JS, Hyun DY, Linder JA, Lynfield R. Prevalence of inappropriate antibiotic prescriptions among US ambulatory care visits, 2010\u20132011. JAMA. 2016;315(17):1864\u201373. https:\/\/doi.org\/10.1001\/jama.2016.4151.","journal-title":"JAMA"},{"issue":"7Supplement","key":"1686_CR2","doi-asserted-by":"publisher","first-page":"S73","DOI":"10.7326\/M18-3442","volume":"171","author":"VM Vaughn","year":"2019","unstructured":"Vaughn VM, Szymczak JE, Newton DW, Fakih MG. Addressing the overuse of cultures to optimize patient care. Ann Intern Med. 2019;171(7Supplement):S73\u20134. https:\/\/doi.org\/10.7326\/M18-3442.","journal-title":"Ann Intern Med"},{"issue":"2","key":"1686_CR3","doi-asserted-by":"publisher","first-page":"515","DOI":"10.1093\/jac\/dky447","volume":"74","author":"KJ Denny","year":"2019","unstructured":"Denny KJ, Gartside JG, Alcorn K, Cross JW, Maloney S, Keijzers G. Appropriateness of antibiotic prescribing in the emergency department. J Antimicrob Chemother. 2019;74(2):515\u201320. https:\/\/doi.org\/10.1093\/jac\/dky447.","journal-title":"J Antimicrob Chemother"},{"issue":"2","key":"1686_CR4","doi-asserted-by":"publisher","first-page":"192","DOI":"10.4161\/viru.23706","volume":"4","author":"C Pulcini","year":"2013","unstructured":"Pulcini C, Gyssens IC. How to educate prescribers in antimicrobial stewardship practices. Virulence. 2013;4(2):192\u2013202. https:\/\/doi.org\/10.4161\/viru.23706.","journal-title":"Virulence"},{"issue":"9","key":"1686_CR5","doi-asserted-by":"publisher","first-page":"935","DOI":"10.15537\/smj.2016.9.16139","volume":"37","author":"HM Zowawi","year":"2016","unstructured":"Zowawi HM. Antimicrobial resistance in Saudi Arabia: An urgent call for an immediate action. Saudi Med J. 2016;37(9):935. https:\/\/doi.org\/10.15537\/smj.2016.9.16139.","journal-title":"Saudi Med J"},{"issue":"12","key":"1686_CR6","doi-asserted-by":"publisher","first-page":"1254","DOI":"10.3390\/pathogens14121254","volume":"14","author":"F Khalid","year":"2025","unstructured":"Khalid F, Aljohani WJ, Akram A, Bukhari A, Khojah OT. Epidemiology and Antimicrobial Resistance of Uropathogens in a Tertiary Care Center in Riyadh, Saudi Arabia: A One-Year Retrospective Analysis. Pathogens. 2025;14(12):1254. https:\/\/doi.org\/10.3390\/pathogens14121254.","journal-title":"Pathogens"},{"issue":"3","key":"1686_CR7","doi-asserted-by":"publisher","first-page":"1133","DOI":"10.4314\/ahs.v20i3.15","volume":"20","author":"LJ Mathibe","year":"2020","unstructured":"Mathibe LJ, Zwane NP. Unnecessary antimicrobial prescribing for upper respiratory tract infections in children in Pietermaritzburg, South Africa. Afr Health Sci. 2020;20(3):1133\u201342. https:\/\/doi.org\/10.4314\/ahs.v20i3.15.","journal-title":"Afr Health Sci"},{"issue":"10459","key":"1686_CR8","doi-asserted-by":"publisher","first-page":"1199","DOI":"10.1016\/S0140-6736(24)01867-1","volume":"404","author":"M Naghavi","year":"2024","unstructured":"Naghavi M, Vollset SE, Ikuta KS, Swetschinski LR, Gray AP, Wool EE, Aguilar GR, Mestrovic T, Smith G, Han C, Hsu RL. Global burden of bacterial antimicrobial resistance 1990\u20132021: a systematic analysis with forecasts to 2050. Lancet. 2024;404(10459):1199\u2013226. https:\/\/doi.org\/10.1016\/S0140-6736(24)01867-1.","journal-title":"Lancet"},{"issue":"8","key":"1686_CR9","doi-asserted-by":"publisher","first-page":"2086","DOI":"10.3390\/microorganisms11082086","volume":"11","author":"AK Thabit","year":"2023","unstructured":"Thabit AK, Alabbasi AY, Alnezary FS, Almasoudi IA. An overview of antimicrobial resistance in Saudi Arabia (2013\u20132023) and the need for national surveillance. Microorganisms. 2023;11(8):2086. https:\/\/doi.org\/10.3390\/microorganisms11082086.","journal-title":"Microorganisms"},{"issue":"1","key":"1686_CR10","doi-asserted-by":"publisher","first-page":"237","DOI":"10.1186\/s12866-019-1612-6","volume":"19","author":"J Al-Zahrani","year":"2019","unstructured":"Al-Zahrani J, Al Dossari K, Gabr AH, Ahmed AF, Al Shahrani SA, Al-Ghamdi S. Antimicrobial resistance patterns of Uropathogens isolated from adult women with acute uncomplicated cystitis. BMC Microbiol. 2019;19(1):237. https:\/\/doi.org\/10.1186\/s12866-019-1612-6.","journal-title":"BMC Microbiol"},{"issue":"6","key":"1686_CR11","doi-asserted-by":"publisher","first-page":"735","DOI":"10.1086\/591126","volume":"47","author":"N Shehab","year":"2008","unstructured":"Shehab N, Patel PR, Srinivasan A, Budnitz DS. Emergency department visits for antibiotic-associated adverse events. Clin Infect Dis. 2008;47(6):735\u201343. https:\/\/doi.org\/10.1086\/591126.","journal-title":"Clin Infect Dis"},{"issue":"3","key":"1686_CR12","doi-asserted-by":"publisher","first-page":"453","DOI":"10.1007\/s40121-017-0168-8","volume":"6","author":"LE Dumkow","year":"2017","unstructured":"Dumkow LE, Beuschel TS, Brandt KL. Expanding antimicrobial stewardship to urgent care centers through a pharmacist-led culture follow-up program. Infect Dis Therapy. 2017;6(3):453\u20139. https:\/\/doi.org\/10.1007\/s40121-017-0168-8.","journal-title":"Infect Dis Therapy"},{"key":"1686_CR13","doi-asserted-by":"publisher","first-page":"101608","DOI":"10.1016\/j.cegh.2024.101608","volume":"27","author":"F Khalawi","year":"2024","unstructured":"Khalawi F, Arain S, Thorakkattil SA, Parakkal SA, Alghashmari FF, Karattuthodi MS, Kunhikatta V, AlHamad HS, Alshammari NE, AlHomoud A. Appropriateness of antibiotic prescribing for urinary tract infection in the emergency department of a tertiary care hospital. Clin Epidemiol Global Health. 2024;27:101608. https:\/\/doi.org\/10.1016\/j.cegh.2024.101608.","journal-title":"Clin Epidemiol Global Health"},{"issue":"1","key":"1686_CR14","doi-asserted-by":"publisher","first-page":"e70378","DOI":"10.1002\/hsr2.70378","volume":"8","author":"KM Alameer","year":"2025","unstructured":"Alameer KM, Abuageelah BM, Alharbi RH, Alfaifi MH, Hurissi E, Haddad M, Dhayhi N, Jafar AS, Mobarki M, Awashi H, Musawi S. Retrospective Analysis of Antibiotic Resistance Patterns of Uropathogenic Escherichia coli With Focus on Extended-Spectrum \u03b2\u2010Lactamase at a Tertiary Central Hospital in Saudi Arabia. Health Sci Rep. 2025;8(1):e70378. https:\/\/doi.org\/10.1002\/hsr2.70378.","journal-title":"Health Sci Rep"},{"key":"1686_CR15","unstructured":"United Arab Emirates Ministry of Health and Prevention, National Antimicrobial Stewardship Committee. National guidelines on the empiric antibiotic treatment of urinary tract infections. Version 1. Abu Dhabi: Ministry of Health and Prevention; 2021 Sep. Available from: https:\/\/dha.gov.ae\/uploads\/082022\/national%20guidelines%20on%20the%20empiric%20antibiotic%20treatment%20of%20urinary%20tract%20infections2022816895.pdf."},{"issue":"5","key":"1686_CR16","doi-asserted-by":"publisher","first-page":"437","DOI":"10.1007\/s40272-021-00466-y","volume":"23","author":"T Stivers","year":"2021","unstructured":"Stivers T. Managing patient pressure to prescribe antibiotics in the clinic. Pediatr Drugs. 2021;23(5):437\u201343. https:\/\/doi.org\/10.1007\/s40272-021-00466-y.","journal-title":"Pediatr Drugs"},{"issue":"4","key":"1686_CR17","doi-asserted-by":"publisher","first-page":"145","DOI":"10.3390\/pharmacy7040145","volume":"7","author":"M Santarossa","year":"2019","unstructured":"Santarossa M, Kilber EN, Wenzler E, Albarillo FS, Sterk EJ. BundlED up: a narrative review of antimicrobial stewardship initiatives and bundles in the emergency department. Pharmacy. 2019;7(4):145. https:\/\/doi.org\/10.3390\/pharmacy7040145.","journal-title":"Pharmacy"},{"issue":"12","key":"1686_CR18","doi-asserted-by":"publisher","first-page":"1297","DOI":"10.3390\/pathogens14121297","volume":"14","author":"SS Mir","year":"2025","unstructured":"Mir SS, Ali E, Alghamdi SA, Alghamdi NM, Alharbi RA, Sindi AA, Zaeri AA. Antimicrobial Resistance in Urinary Tract Infections Among Patients with and Without Renal Comorbidities: A Retrospective Study from Al-Baha, Saudi Arabia. Pathogens. 2025;14(12):1297. https:\/\/doi.org\/10.3390\/pathogens14121297.","journal-title":"Pathogens"},{"issue":"6","key":"1686_CR19","doi-asserted-by":"publisher","first-page":"875","DOI":"10.1177\/0897190020930979","volume":"34","author":"K Stoll","year":"2021","unstructured":"Stoll K, Feltz E, Ebert S. Pharmacist-Driven Implementation of Outpatient Antibiotic Prescribing Algorithms Improves Guideline Adherence in the Emergency Department. J Pharm Pract. 2021;34(6):875\u201381. https:\/\/doi.org\/10.1177\/0897190020930979.","journal-title":"J Pharm Pract"},{"issue":"2","key":"1686_CR20","doi-asserted-by":"publisher","first-page":"190","DOI":"10.1177\/0897190011420160","volume":"25","author":"SN Baker","year":"2012","unstructured":"Baker SN, Acquisto NM, Ashley ED, Fairbanks RJ, Beamish SE, Haas CE. Pharmacist-managed antimicrobial stewardship program for patients discharged from the emergency department. J Pharm Pract. 2012;25(2):190\u20134. https:\/\/doi.org\/10.1177\/0897190011420160.","journal-title":"J Pharm Pract"},{"issue":"7","key":"1686_CR21","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1093\/cid\/ciac073","volume":"75","author":"CL Nys","year":"2022","unstructured":"Nys CL, Fischer K, Funaro J, Shoff CJ, Theophanous RG, Staton CA, Mando-Vandrick J, Toler R, Shroba J, Turner NA, Liu B, Lee HJ, Moehring RW, Wrenn RH. Impact of Education and Data Feedback on Antibiotic Prescribing for Urinary Tract Infections in the Emergency Department: An Interrupted Time-Series Analysis. Clin Infect Dis. 2022;75(7):11.","journal-title":"Clin Infect Dis"}],"container-title":["BMC Emergency Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12873-026-01686-6","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12873-026-01686-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12873-026-01686-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T02:08:02Z","timestamp":1792634882000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12873-026-01686-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,25]]},"references-count":21,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["1686"],"URL":"https:\/\/doi.org\/10.1186\/s12873-026-01686-6","relation":{},"ISSN":["1471-227X"],"issn-type":[{"value":"1471-227X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,25]]},"assertion":[{"value":"22 September 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 July 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 July 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Ethical approval was granted by the Institutional Review Board of King Abdullah International Medical Research Centre (KAIMRC), Jeddah, Saudi Arabia (IRB number NRJ23J\/194\/07).","order":1,"name":"Ethics","label":"Ethical approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"285"}}