Effect of Urine Point-of-Care Gram Staining on Broad-spectrum Antibiotic Use in Febrile Urinary Tract Infections

Background: Febrile urinary tract infections (fUTIs) are commonly treated empirically with broad-spectrum antibiotics because of concerns regarding antimicrobial resistance. Although Gram staining is widely used in clinical laboratories, operational constraints often limit its use during regular working hours. Some facilities have implemented point-of-care Gram staining (PCGS) to enable timely results and treatment decisions, even outside regular hours. However, the effect of urine PCGS on reducing broad-spectrum antibiotic use remains unclear. Methods: This single-center observational study (April 2015–March 2024) included patients aged ≥15 years admitted with suspected fUTIs. Initial antibiotic therapy was chosen based on urine PCGS results (PCGS group) or empirically without Gram staining (Empiric group). The groups were compared regarding the proportion of Access antibiotics prescribed (WHO AWaRe classification), antibiotic spectrum, culture-based appropriateness, pharmaceutical costs, and time to initial antibiotic administration. Results: Among 251 patients (PCGS: 184; Empiric: 67), the PCGS group exhibited a higher use of Access antibiotics (15.2% vs. 4.5%, p =0.022) and narrow-spectrum agents (28.8% vs. 4.5%, p <0.001), without compromising efficacy (95.1% vs. 89.5%, p =0.22). The median antibiotic cost per day was lower in the PCGS group (486 vs. 844 JPY, p <0.001). The time to initial antibiotic administration was shorter in the PCGS group, particularly when division members were directly involved (89 vs. 123 min, p =0.0004). Conclusions: Urine PCGS enabled narrower-spectrum antibiotic selection and greater use of Access antibiotics than empiric therapy, while maintaining clinical effectiveness and reducing both pharmaceutical costs and time to treatment initiation.