Impact of Clinical Flowcharts on Therapeutic Adherence, Treatment Duration, and Clinical Outcomes in Urinary Tract Infections: A Quasi-Experimental Study in a Colombian University Hospital

Background Urinary tract infections (UTIs) are a common cause of hospitalization and antimicrobial use. This study evaluated the impact of clinical flowcharts on adherence to empirical treatment and clinical outcomes in hospitalized patients with UTIs. Methods A quasi-experimental, ambispective before-and-after study was conducted at a tertiary university hospital in Bogotá, Colombia (January 2023–January 2025). Adult patients with community-acquired UTIs were included. Flowcharts based on guidelines, local susceptibility patterns, and drug availability were implemented. Outcomes included adherence (type, dose, duration), de-escalation, oral switch, clinical response, length of stay, and readmission. Analyses were adjusted using inverse probability of treatment weighting (IPTW). Results A total of 601 patients were analyzed (299 pre- and 302 post-intervention). Overall adherence improved from 38.1% to 51.6% (p < 0.001). Increases were also observed in adherence to antibiotic type (76.9% vs. 85.4%), dose (76.9% vs. 88.1%), and duration (48.8% vs. 59.9%). Post-intervention was independently associated with greater adherence (aOR: 1.61; 95% CI: 1.15–2.24; p = 0.005), without significant impact on clinical outcomes. Discussion Flowcharts improved adherence to empirical therapy without compromising safety or effectiveness, reinforcing their value in antimicrobial stewardship programs. Conclusions Clinical flowcharts are effective tools for standardizing empirical UTI management in high-resistance settings.