Evaluating Compliance with National Guidelines for Urinary Tract Infection Treatment in Lebanese Hospitals: A Multicenter Cross-Sectional Study

Background: Inappropriate antibiotic prescribing for urinary tract infections (UTIs) is a major issue in Lebanon, leading to increased antimicrobial resistance (AMR). This study assesses antibiotic-prescribing practices and evaluates physicians' adherence to national guidelines for UTI management in hospitalized patients, while also identifying factors linked to inappropriate prescribing. Methods: This cross-sectional study was conducted in five university hospitals across Lebanon from March 2022 to December 2023. Prescribed antibiotics were compared against the Lebanese national guidelines for UTIs. Data analysis utilized IBM SPSS® version 27, incorporating descriptive statistics, bivariate analysis, and multivariable logistic regression, with significance set at p ≤ 0.05. Results: The study included 401 patients (61.8 % females), with a mean age of 64.81 years. Appropriate antibiotic prescribing occurred in 52.4 % of cases, highest in complicated pyelonephritis (62.3 %) and lowest in uncomplicated pyelonephritis (38.7 %). Bivariate analysis linked older age (p = 0.042), flank pain (p < 0.001), nausea/vomiting (p = 0.001), and frequency/urgency (p = 0.007) to appropriate treatment. Physician position significantly impacted adherence (consultants: 81.8 % vs. residents: 32.4 %, p < 0.001). Multivariable analysis showed that carbapenems (OR: 1.76, p = 0.032) and fluoroquinolones (OR: 9.49, p < 0.001) were associated with inappropriate prescribing. Conclusions: The study reveals widespread non-compliance with UTI treatment guidelines in Lebanon, leading to inappropriate antibiotic use and AMR. It is recommended that educational programs, prescribing audits, and improved residency training be implemented. Reinforcement of Antimicrobial Stewardship Programs, the use of clinical decision support tools, and the enhancement of regulatory frameworks are key steps to improve guideline adherence and combat AMR.