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BACKGROUND: The simplified HOSPITAL score is an easy-to-use prediction model to identify patients at high risk of 30-day readmission before hospital discharge. An earlier stratification of this risk would allow more preparation time for transitional care interventions. OBJECTIVE: To assess whether the simplified HOSPITAL score would perform similarly by using hemoglobin and sodium level at the time of admission instead of discharge. DESIGN: Prospective national multicentric cohort study. PARTICIPANTS: In total, 934 consecutively discharged medical inpatients from internal general services. MAIN MEASURES: We measured the composite of the first unplanned readmission or death within 30 days after discharge of index admission and compared the performance of the simplified score with lab at discharge (simplified HOSPITAL score) and lab at admission (early HOSPITAL score) according to their discriminatory power (Area Under the Receiver Operating characteristic Curve (AUROC)) and the Net Reclassification Improvement (NRI). KEY RESULTS: During the study period, a total of 3239 patients were screened and 934 included. In total, 122 (13.2%) of them had a 30-day unplanned readmission or death. The simplified and the early versions of the HOSPITAL score both showed very good accuracy (Brier score 0.11, 95%CI 0.10-0.13). Their AUROC were 0.66 (95%CI 0.60-0.71), and 0.66 (95%CI 0.61-0.71), respectively, without a statistical difference (p value 0.79). Compared with the model at discharge, the model with lab at admission showed improvement in classification based on the continuous NRI (0.28; 95%CI 0.08 to 0.48; p value 0.004). CONCLUSION: The early HOSPITAL score performs, at least similarly, in identifying patients at high risk for 30-day unplanned readmission and allows a readmission risk stratification early during the hospital stay. Therefore, this new version offers a timely preparation of transition care interventions to the patients who may benefit the most.
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The Covid-19 epidemic has turned our lives upside down; surprisingly certain aspects of this infection can also make you smile, as well as certain modes of transmission of infectious agents that we have grouped together in the form of an original "blooper" of infectious diseases.
L'épidémie de Covid-19 a bouleversé notre vie. Étonnamment, certains aspects de cette infection peuvent aussi faire sourire, tout comme certains modes de transmission d'agents infectieux que nous avons regroupés sous la forme d'un « bêtisier ¼ original des maladies infectieuses.
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COVID-19 , Doenças Transmissíveis , COVID-19/epidemiologia , Doenças Transmissíveis/epidemiologia , HumanosRESUMO
This article reviews the clinical implications and limitations of the number needed to treat (NNT). Clinicians can quickly use this rather intuitive statistical value to assess the expected effectiveness of a treatment and explain it to patients. However, careful attention must be paid to the outcomes used in defining an NNT, as well as, the rate of the specific event in the population and the duration of observation. Conflicts of interest may also affect this easily manipulated statistical tool. Some often prescribed treatments have an NNT well above 20, implying an uncertain benefit for the patient, which emphasizes the need to carefully weigh the risk-benefit balance (NNT vs. NNH: number needed to harm) when prescribing. This review shows particularly low NNTs for anti-infectious agents compared to other drugs frequently used in medical practice.
Cet article revoit les implications cliniques et les limitations du NNT (Number Needed to Treat). C'est une valeur intuitive rapidement utilisable afin d'évaluer l'efficacité attendue d'un traitement et facilement abordable pour le patient. Cependant, on restera très attentif aux issues cliniques étudiées, au risque de base de l'événement dans la population et à la durée d'observation utilisés. Des conflits d'intérêts peuvent aussi affecter cet outil statistique facilement manipulable. Certains traitements largement prescrits présentent un NNT au-delà de 20, donc un bénéfice incertain pour le patient, imposant de soigneusement peser la balance risques-bénéfices (NNT vs NNH (Number Needed to Harm)) lors de la prescription initiale. Le NNT est particulièrement bas pour les agents anti-infectieux, comparés à d'autres traitements courants.
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Medição de Risco , HumanosRESUMO
Drug fever is a little known side effect and should be considered as a differential diagnosis in the presence of fever. Its early recognition is important to avoid unnecessary investigations. Among the 70 most prescribed drugs in primary care in Switzerland, 8 have been linked to drug feverâ : amoxicillin, atorvastatin, rosuvastatin, esomeprazole, pantoprazole, rivaroxaban, salbutamol and trazodone. There are no specific criterias to distinguish a drug-induced fever. The diagnosis is confirmed with a positive rechallenge test. If a drug fever is suspected, it is recommended to stop the offending agent.
La fièvre d'origine médicamenteuse fait partie du diagnostic différentiel de toute fièvre et est un effet secondaire peu reconnu. Son évocation précoce est importante et permet d'éviter des examens secondaires inutiles. Parmi les 70 substances les plus vendues en ambulatoire en Suisse de 2008 à 2016, 8 médicaments peuvent provoquer de la fièvreâ : l'amoxicilline, l'atorvastatine, la rosuvastatine, l'esoméprazole, le pantoprazole, le rivaroxaban, le salbutamol et la trazodone. Il n'y a pas de critère défini de la fièvre médicamenteuse et aucun signe clinique ou valeur de laboratoire n'est spécifique à un état fébrile secondaire à un médicament. Seul un test de réexposition positif permet de confirmer définitivement le diagnostic. En cas de suspicion de fièvre médicamenteuse, l'arrêt immédiat de la substance est recommandé.
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Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Febre , Febre/etiologia , Humanos , Atenção Primária à Saúde , SuíçaRESUMO
Viral infections are extremely common and generally self-restricted, thus antiviral therapy is limited to precise indications. Apart from HIV (not reviewed in this article), the principal treatable viruses are HSV 1 and 2, VZV, CMV, Influenza A and B, and hepatitis B and C. Vaccination is another cornerstone of viral infections control. This article summarizes actual and available therapy. New treatments arrived recently on the market or are being developedâ : HCV can now be treated with a high success rate, baloxavir against the flu, a new zoster vaccine will probably soon be available in Switzerland and letermovir improves CMV prophylaxis in the case of hematopoietic stem cell transplant.
Les infections virales sont extrêmement fréquentes et guérissent le plus souvent spontanément. Un traitement antiviral est réservé à des indications précises. A l'exception du VIH (non abordé dans cet article), les principaux virus traitables sontâ : herpès simplex 1 et 2 (HSV-1 et 2), Varicella zoster (VZV), cytomégalovirus (CMV), influenza A et B ainsi que les virus des hépatites B et C. La vaccination est une autre stratégie de lutte importante. Ce domaine étant en plein développement, cet article effectue un survol des traitements actuellement disponibles sur le marché suisse. Durant ces dernières années, l'hépatite C a pu être traitée avec un haut taux de succès. Le baloxavir contre la grippe et un nouveau vaccin contre le zona seront sans doute prochainement disponibles en Suisse. Le letermovir améliore la prophylaxie du CMV en cas de transplantation de moelle osseuse.
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Antivirais/uso terapêutico , Medicina Geral , Viroses/tratamento farmacológico , Clínicos Gerais , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Humanos , Suíça , Vacinas Virais/provisão & distribuição , Viroses/prevenção & controle , Viroses/virologiaRESUMO
Infectious diseases is known as a serious medical discipline. Nevertheless some experiences related by patients and unusual studies can bring a smile on your face. In this article, you will find a sample of rare and original studies in this field, extracted from a collection of comical published medical articles.
L'infectiologie est une discipline de réputation sérieuse, pourtant certaines études originales ou les expériences des patients adressés pour une maladie infectieuse peuvent parfois faire sourire. Sorti d'une collection d'articles rares et originaux, vous trouverez ci-après un échantillon de particularités infectiologiques que vous ne trouverez pas ailleurs.
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Several outbreaks have made the news in 2016 : Ebola has come at an end, Zika is booming and a resurgence of yellow fever takes place in Africa. In Switzerland, two hospital outbreaks have been reported, caused by Mycobacterium chimerae and Burkholderia cepacia. A major new article has consolidated the notion that prolonged antibiotic therapy is unnecessary in Lyme disease. As multiresistant bacteria are increasing in frequency, innovative therapeutic approaches are under development. For lung infections, sensitive and specific methods are in need to refine their etiological diagnosis. In pneumonia, therapy can be shortened without risk compared with usual practice. Finally, the epidemiology of bacterial meningitis has changed in the last 10 years, with a decrease of incidence.
Plusieurs épidémies ont fait l'actualité en 2016 : celle d'Ebola qui est arrivée à son terme, celle de Zika qui est en pleine expansion et une résurgence de la fièvre jaune sur le continent africain. En Suisse, deux épidémies hospitalières ont été rapportées, dues aux bactéries Mycobacterium chimerae et Burkholderia cepacia. Un nouvel article majeur a consolidé la notion que l'antibiothérapie prolongée est inutile dans la maladie de Lyme. Les bactéries multirésistantes augmentent en fréquence ; des approches thérapeutiques innovatrices sont en développement. Pour les infections pulmonaires, on est toujours à la recherche de méthodes sensibles et spécifiques pour affiner le diagnostic étiologique. Dans la pneumonie, la durée du traitement peut être raccourcie sans risque par rapport à ce qui se fait usuellement. Enfin, l'épidémiologie des méningites bactériennes a beaucoup changé ces 10 dernières années, avec une diminution de l'incidence de cette maladie.
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Doenças Transmissíveis , Antibacterianos/classificação , Antibacterianos/isolamento & purificação , Antibacterianos/uso terapêutico , Doenças Transmissíveis/diagnóstico , Doenças Transmissíveis/epidemiologia , Doenças Transmissíveis/terapia , Doenças Transmissíveis Emergentes/microbiologia , Doenças Transmissíveis Emergentes/terapia , Doenças Transmissíveis Emergentes/virologia , Farmacorresistência Bacteriana Múltipla , Epidemias/estatística & dados numéricos , Humanos , Doença de Lyme/terapia , Meningites Bacterianas/diagnóstico , Meningites Bacterianas/epidemiologia , Meningites Bacterianas/terapia , Infecções Respiratórias/tratamento farmacológico , Infecções Respiratórias/epidemiologia , Viroses/diagnóstico , Viroses/epidemiologia , Viroses/terapiaRESUMO
In a world where the emergence of resistant bacteria threatens the future use of many antibiotics, it is now critical to prescribe antibiotics carefully in order to minimize selective pressure. Limiting treatment duration would be one of the strategies to achieve this goal. Recent studies state that a reduction of the course of treatment is showing great benefit with no outcome difference.
Dans un contexte où les antibiotiques sont menacés par l'émergence de résistances bactériennes, il semble essentiel de développer des mesures pour une meilleure gestion de ces derniers, ce qui se résume par le concept d'antibiotic stewardship. Un des moyens de parvenir à cet objectif est la réduction de la durée de l'antibiothérapie. A cet effet, des études récentes ont énoncé des arguments en faveur de durées réduites de traitement.
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Antibacterianos , Antibacterianos/administração & dosagem , Esquema de Medicação , Farmacorresistência BacterianaRESUMO
BACKGROUND: Lifestyle changes and statins are the cornerstones in management of dyslipidaemia in patients with HIV infection. Replacement of an antiretroviral therapy (ART) component is a proposed therapeutic strategy to reduce cardiovascular risk. In dyslipidaemic patients with HIV infection, we assessed the efficacy of replacing boosted protease inhibitor (bPI) or efavirenz (EFV) by etravirine (ETR) as an alternative to statin therapy. MATERIALS AND METHODS: A prospective, open-label, multicentre, 12-week study of patients with HIV infection on ART including bPI or EFV, and statin treatment. Four weeks after statin interruption, bPI or EFV was switched to ETR (400 mg, 8 weeks) if serum low-density lipoprotein cholesterol (LDL-C) was ≥ 3 mM. The primary endpoint was the proportion of patients on ETR with no indication for statin treatment at study completion. Serum levels of HIV RNA, lipids and biomarkers of cardiovascular disease were also measured. (ClinicalTrials.gov: NCT01543035). RESULTS: The 31 included patients had a HIV-1 RNA < 50 copies/mL (median age, 52 years; median CD4, 709 cell/mL; median LDL-C, 2·89 mM), 68% were on EFV, and 32% were on bPI. At week 4, 27 patients switched to ETR. At study completion, 15 patients (56%) on ETR did not qualify for statin treatment. After the ETR switch, serum levels of the cardiovascular biomarkers sICAM and MCP1/CCL2 decreased by 11·2% and 18·9%, respectively, and those of CCL5/RANTES and tissue inhibitor of metalloproteinase-1 increased by 14·3% and 13·4%, respectively, indicating reduced cardiovascular risk. There were no notable treatment-related adverse events. CONCLUSIONS: Replacing bPI or EFV by ETR is a viable strategy to obviate primary prevention statin treatment.
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Doenças Cardiovasculares/prevenção & controle , Dislipidemias/tratamento farmacológico , Infecções por HIV/tratamento farmacológico , HIV-1 , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Inibidores da Transcriptase Reversa/uso terapêutico , Adolescente , Adulto , Idoso , Alcinos , Benzoxazinas/uso terapêutico , Biomarcadores/metabolismo , Ciclopropanos , Substituição de Medicamentos , Feminino , Humanos , Metabolismo dos Lipídeos/fisiologia , Masculino , Pessoa de Meia-Idade , Nitrilas , Estudos Prospectivos , Piridazinas/uso terapêutico , Pirimidinas , Adulto JovemRESUMO
Recent European Association of Urology (EAU) guidelines and a clinical prediction rule developed by Van Nieuwkoop et al. suggest simple criteria for performing radiological imaging for patients with a febrile urinary tract infection (UTI). We analysed the records of patients with a UTI from four hospitals in Switzerland. Of 107 UTI patients, 58% underwent imaging and 69% (95%CI: 59-77%) and 64% (95%CI: 54-73%) of them were adequately managed according to Van Nieuwkoop's clinical rule and EAU guidelines, respectively. However, only 47% (95%CI: 33-61%) and 57% (95%CI: 44-69%) of the imaging performed would have been recommended according to their respective rules. Clinically significant imaging findings were associated with a history of urolithiasis (OR = 11.8; 95%CI: 3.0-46.5), gross haematuria (OR = 5.9; 95%CI: 1.6-22.1) and known urogenital anomalies (OR = 5.7; 95%CI: 1.8-18.2). Moreover, six of 16 (38%) patients with a clinically relevant abnormality displayed none of the criteria requiring imaging according to Van Nieuwkoop's rule or EAU guidelines. Thus, adherence to imaging guidelines was suboptimal, especially when imaging was not recommended. However, additional factors associated with clinically significant findings suggest the need for a new, efficient clinical prediction rule.
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OBJECTIVES: 1) To identify predictors of one-year mortality in hospitalized medical patients using factors available during their hospital stay. 2) To evaluate whether healthcare system use within 30 days of hospital discharge is associated with one-year mortality. STUDY DESIGN AND SETTING: This prospective, observational study included adult patients from four mid-sized hospital general internal medicine units. During index hospitalization, we retrieved patient characteristics, including demographic and socioeconomic indicators, diagnoses, and early simplified HOSPITAL scores from electronic health records and patient interviews. Data on healthcare system use was collected using telephone interviews 30 days after discharge. Survival status at one year was collected by telephone and from health records. We used a univariable analysis including variables available from the hospitalization and 30-day post-discharge periods. We then performed multivariable analyses with one model using index hospitalization data and one using 30-day post-discharge data. RESULTS: Of 934 patients, 123 (13.2%; 95% CI 11.0-15.4%) were readmitted or died within 30 days. Of 814 patients whose primary outcome was available, 108 died (13.3%) within one year. Using factors obtained during hospitalization, the early simplified HOSPITAL score (OR 1.50; 95% CI 1.31-1.71; P < 0.001) and not living at home (OR 4.0; 95% CI 1.8-8.3; P < 0.001) were predictors of one-year mortality. Using 30-day post-discharge predictors, hospital readmission was significantly associated with one-year mortality (OR 4.81; 95% CI 2.77-8.33; P < 0.001). SIGNIFICANCE: Factors predicting one-year mortality were a high early simplified HOSPITAL score, not living at home, and a 30-day unplanned readmission.
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Assistência ao Convalescente , Alta do Paciente , Adulto , Humanos , Estudos Prospectivos , Fatores de Risco , Readmissão do Paciente , Hospitais , Estudos Retrospectivos , Mortalidade HospitalarRESUMO
Hospital readmissions within 30 days represent a burden for the patients and the entire health care system. Improving the care around hospital discharge period could decrease the risk of avoidable readmissions. We describe the methods of a trial that aims to evaluate the effect of a structured multimodal transitional care intervention targeted to higher-risk medical patients on 30-day unplanned readmissions and death. The TARGET-READ study is an investigator-initiated, pragmatic single-blinded randomized multicenter controlled trial with two parallel groups. We include all adult patients at risk of hospital readmission based on a simplified HOSPITAL score of ≥4 who are discharged home or nursing home after a hospital stay of one day or more in the department of medicine of the four participating hospitals. The patients randomized to the intervention group will receive a pre-discharge intervention by a study nurse with patient education, medication reconciliation, and follow-up appointment with their referring physician. They will receive short follow-up phone calls at 3 and 14 days after discharge to ensure medication adherence and follow-up by the ambulatory care physician. A blind study nurse will collect outcomes at 1 month by phone call interview. The control group will receive usual care. The TARGET-READ study aims to increase the knowledge about the efficacy of a bundled intervention aimed at reducing 30-day hospital readmission or death in higher-risk medical patients.
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Importance: Hospital readmissions are frequent, costly, and sometimes preventable. Although these issues have been well publicized and incentives to reduce them introduced, the best interventions for reducing readmissions remain unclear. Objectives: To evaluate the effects of a multimodal transitional care intervention targeting patients at high risk of hospital readmission on the composite outcome of 30-day unplanned readmission or death. Design, Setting, and Participants: A single-blinded, multicenter randomized clinical trial was conducted from April 2018 to January 2020, with a 30-day follow-up in 4 medium-to-large-sized teaching hospitals in Switzerland. Participants were consecutive patients discharged from general internal medicine wards and at higher risk of unplanned readmission based on their simplified HOSPITAL score (≥4 points). Data were analyzed between April and September 2022. Interventions: The intervention group underwent systematic medication reconciliation, a 15-minute patient education session with teach-back, a planned first follow-up visit with their primary care physician, and postdischarge follow-up telephone calls from the study team at 3 and 14 days. The control group received usual care from their hospitalist, plus a 1-page standard study information sheet. Main Outcomes and Measures: Thirty-day postdischarge unplanned readmission or death. Results: A total of 1386 patients were included with a mean (SD) age of 72 (14) years; 712 (51%) were male. The composite outcome of 30-day unplanned readmission or death was 21% (95% CI, 18% to 24%) in the intervention group and 19% (95% CI, 17% to 22%) in the control group. The intention-to-treat analysis risk difference was 1.7% (95% CI, -2.5% to 5.9%; P = .44). There was no evidence of any intervention effects on time to unplanned readmission or death, postdischarge health care use, patient satisfaction with the quality of their care transition, or readmission costs. Conclusions and Relevance: In this randomized clinical trial, use of a standardized multimodal care transition intervention targeting higher-risk patients did not significantly decrease the risks of 30-day postdischarge unplanned readmission or death; it demonstrated the difficulties in preventing hospital readmissions, even when multimodal interventions specifically target higher-risk patients. Trial Registration: ClinicalTrials.gov Identifier: NCT03496896.
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Readmissão do Paciente , Cuidado Transicional , Humanos , Masculino , Idoso , Feminino , Alta do Paciente , Assistência ao Convalescente , Hospitais de EnsinoRESUMO
OBJECTIVES: The aim of the study was to analyse the proportion of evidence-based medication displayed in pharmacies and compare it between the different linguistic regions of the country, at different times of the year to determine the amount of proven effective medications indirectly recommended to the public in different parts of Switzerland. DESIGN: This is an observational study conducted by medical doctors in the department of internal medicine at the Spitalzentrum Biel, Switzerland. SETTING: The observation took place from July 2019 to May 2020. From a total of 1800 pharmacies in Switzerland, 68 different pharmacies were selected across the 3 main linguistic regions and the medication on display in their windows were examined 4 times a year regarding their efficacy. The displays of medication with or without evidence-based efficacy were described using absolute numbers and proportions and compared between the different linguistic regions at different seasons using χ2. PARTICIPANTS: There were no human or animal participants involved in this study. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome is the proportion of medication displayed in pharmacy windows with a proven effectiveness in medical literature. The secondary outcome was the variability of the primary outcome over time (seasonal changes), over the different linguistic regions of Switzerland and between chains and privately owned pharmacies. RESULTS: We examined 970 medications and found that over the whole year, there is a high proportion of non-evidence-based drugs (56,9%) displayed in pharmacies. Swiss German cantons display significantly more non-evidence-based medications in winter. We found no statistical difference for other seasons or between chains and privately owned pharmacies. CONCLUSION: Pharmacies in Switzerland tend to display significantly more non-evidence-based drugs, thus indirectly recommending them to the public. In a time of necessary expansion of self-medication by the population, this could incite consumers to buy drugs without proven effectiveness.
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Farmácias , Farmácia , Humanos , Publicidade , Medicina Baseada em Evidências , SuíçaRESUMO
INTRODUCTION: Burnout and low job satisfaction are increasing among the General Internal Medicine (GIM) workforce. Whether part-time compared to full-time clinical employment is associated with better wellbeing, job satisfaction and health among hospitalists remains unclear. MATERIALS AND METHODS: We conducted an anonymized cross-sectional survey among board-certified general internists (i.e. hospitalists) from GIM departments in 14 Swiss hospitals. Part-time clinical work was defined as employment of <100% as a clinician. The primary outcome was well-being, as measured by the extended Physician Well-Being Index (ePWBI), an ePWBI ≥3 indicating poor wellbeing. Secondary outcomes included depressive symptoms, mental and physical health, and job satisfaction. We compared outcomes in part-time and full time workers using propensity score-adjusted multivariate regression models. RESULTS: Of 199 hospitalists invited, 137 (69%) responded to the survey, and 124 were eligible for analysis (57 full-time and 67 part-time clinicians). Full-time clinicians were more likely to have poor wellbeing compared to part-time clinicians (ePWBI ≥3 54% vs. 31%, p = 0.012). Part-time compared to full-time clinical work was associated with a lower risk of poor well-being in adjusted analyses (odds ratio 0.20, 95% confidence interval 0.07-0.59, p = 0.004). Compared to full-time clinicians, there were fewer depressive symptoms (3% vs. 18%, p = 0.006), and mental health was better (mean SF-8 Mental Component Summary score 47.2 vs. 43.2, p = 0.028) in part-time clinicians, without significant differences in physical health and job satisfaction. CONCLUSIONS: Full-time clinical hospitalists in GIM have a high risk of poor well-being. Part-time compared to full-time clinical work is associated with better well-being and mental health, and fewer depressive symptoms.
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OBJECTIVES: Urinary culture sensitivity after antibiotics administration is unknown. This study aimed to describe the diagnostic sensitivity of urine cultures from patients' first, second, and third micturition samples after a single dose of empirical antibiotics given for upper and/or febrile urinary tract infections, as well as searched for factors influencing diagnostic sensitivity over time. METHODS: We collected consecutive urine samples from adult patients with an upper or febrile urinary tract infection diagnosed at four secondary hospital emergency rooms. One sample was collected before a first dose of empirical antibiotic treatment and up to three samples were collected from consecutive postadministration micturition. The main outcome was the number of positive cultures growing uropathogens with ≥103 colony forming units (CFUs) for men and ≥104 for women. Identical analyses were performed for any identified CFU and ≥105 CFU cut-off points. Time between antibiotic administration and first negative urinary culture was noted, which could have been at the time of any of the three postantibiotic urine samples. We used a Cox regression analysis for age- and sex-adjusted analyses. RESULTS: A total of 86 of 87 patients' preantibiotic cultures (99%) were positive compared with 26 of 75 (35%; p < 0.001), 15 of 50 (30%; p < 0.001), and 1 of 15 (7%; p < 0.001) of the first, second, and third postantibiotic samples, respectively, and missing 14 of 21 (67%), 13 of 17 (76%), and 7 of 7 (100%) of uropathogens with antibiotic resistance, respectively. The times needed for 25%, 50%, and 75% of cultures to be negative were 1.5, 2.9, and 9 hours, respectively, after antibiotic administration. Older age, male sex, non-Escherichia coli pathogens, urinary tract disease, comorbidity burdens, and urinary catheters prolonged time to negative culture, but were not significantly associated after adjustment. Uropathogens were found at ≥105 CFU in 15 of 75 (20%), 7 of 50 (14%), and 0 of 15 (0%) of the three postantibiotic micturition samples, respectively, and in any identified CFU in 48 of 75 (64%), 23 of 50 (46%), and 1 of 15 (7%), respectively. CONCLUSION: Urinary culture sensitivity decreases rapidly after administering antibiotics.