Analysis of Recurrent Urinary Tract Infection Management in Women Seen in Outpatient Settings Reveals Opportunities for Antibiotic Stewardship Interventions

Authors

Marissa A Valentine-King
Barbara W Trautner
Roger J Zoorob
George Germanos
Michael Hansen
Jason L Salemi
Kalpana Gupta
Larissa Grigoryan

Publication Date

1-1-2022

Journal

Antimicrobial Stewardship & Healthcare Epidemiology

DOI

10.1017/ash.2021.224

PMID

36310787

PMCID

PMC9614978

PubMedCentral® Posted Date

1-17-2022

PubMedCentral® Full Text Version

Post-Print

Published Open-Access

yes

Abstract

OBJECTIVES: We characterized antibiotic prescribing patterns and management practices among recurrent urinary tract infection (rUTI) patients, and we identified factors associated with lack of guideline adherence to antibiotic choice, duration of treatment, and urine cultures obtained. We hypothesized that prior resistance to nitrofurantoin or trimethoprim-sulfamethoxazole (TMP-SMX), shorter intervals between rUTIs, and more frequent rUTIs would be associated with fluoroquinolone or β-lactam prescribing, or longer duration of therapy.

METHODS: This study was a retrospective database study of adult women with

RESULTS: Among 214 patients with 566 visits, 61.5% of prescriptions comprised first-line agents of nitrofurantoin (39.7%) and TMP-SMX (21.5%), followed by second-line choices of fluoroquinolones (27.2%) and β-lactams (11%). Most fluoroquinolone prescriptions (86.7%), TMP-SMX prescriptions (72.2%), and nitrofurantoin prescriptions (60.2%) exceeded the guideline-recommended duration. Approximately half of visits lacked a urine culture. Receiving care through urology via telephone was associated with receiving a β-lactam (adjusted odds ratio [aOR], 6.34; 95% confidence interval [CI], 2.58-15.56) or fluoroquinolone (OR, 2.28; 95% CI, 1.07-4.86). Having >2 rUTIs during the study period and seeking care from a urology practice (RR, 1.28, 95% CI, 1.15-1.44) were associated with longer antibiotic duration.

CONCLUSIONS: We found low guideline concordance for antibiotic choice, duration of therapy and cultures obtained among rUTI patients. These factors represent new targets for outpatient antibiotic stewardship interventions.

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