Adherence to guideline recommendations for urinary tract infections in adult women: a cross-sectional study

Zande, Rian Lelie-van der; Bouvy, Marcel L.; Teichert, Martina

doi:10.1017/s1463423621000116

Cited by 7 publications

(3 citation statements)

References 27 publications

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“…Second, the Urologic Diseases in America study defined UTI by diagnostic coding plus the filling of an antibiotic prescription within 72 hours (and did not include the requirement for urine culture order in their inclusion criteria). Knowing that adherence to guidelines recommending urine culture before treatment in women with recurrent UTI is low, 8 our study may have underestimated those treated for possible UTI without a urine culture order. Conversely, the 30% number from the urologic disease project study could be overestimating the number of true UTIs.…”

Section: Discussionmentioning

confidence: 83%

Characteristics Associated With Repeated Evaluations for Urinary Tract Infections in Older Women: A Case-Control Study

Bradley

Stanger

Ford

et al. 2022

Female Pelvic Med Reconstr Surg

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ObjectivesThe aims of this study were to estimate the incidence of repeated evaluations for urinary tract infection (UTI) after a single occurrence and to identify characteristics associated with repeated evaluations in a female Medicare population.MethodsThis was a case-control study of women aged 65 years or older undergoing incident outpatient evaluation for UTI between the years of 2011 and 2018. We defined UTI evaluation as an outpatient encounter with diagnostic codes for UTI and an order for urine culture. We excluded women with diagnostic codes suggestive of a complicated UTI. Among all women with an incident UTI evaluation, cases were defined as those with repeated evaluations, defined as either a total of ≥2 UTI evaluations in 6 months and/or ≥3 in 1 year. The characteristics of cases versus controls were compared with both an unadjusted and adjusted logistic regression model.ResultsOur overall cohort consisted of 169,958, of which 13,779 (8.1%) had repeated evaluations for UTI. In unadjusted analyses, cases were more likely to be older than 75 years, of White race, and to have cardiovascular conditions, diabetes, dementia, renal disease, and chronic obstructive pulmonary disease (all P's < 0.01) as compared with controls. In adjusted analysis, ages 75 years to 84 years (P < 0.01) and ages older than 84 years (P < 0.01) along with multiple medical comorbidities were significant risk factors for repeated evaluations for UTI. Black women had lower odds of repeated evaluations for UTI (P < 0.01).ConclusionsAmong women with a single UTI evaluation, repeated evaluations for UTI were associated with older age, White race, and medical comorbidities. Future studies should investigate racial disparities seen in care-delivery behavior and/or care-seeking behavior.

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Section: Discussionmentioning

confidence: 83%

Characteristics Associated With Repeated Evaluations for Urinary Tract Infections in Older Women: A Case-Control Study

Bradley

Stanger

Ford

et al. 2022

Female Pelvic Med Reconstr Surg

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“…In the Netherlands, 12–28% of E. coli strains isolated from urine in 2014 were resistant to trimethoprim [ 35 ]. In accordance with international guidelines, current Dutch guidelines around UTI care consequently recommended trimethoprim as the third drug of choice, behind nitrofurantoin and fosfomycin [ 36 , 37 ]. Therefore, while trimethoprim was a useful drug to promote at the time of the studies included in this review (and is definitely preferable to quinolones for the treatment of an uncomplicated UTI), any future interventions should focus on the use of any of the other antibiotics recommended by the guidelines.…”

Section: Discussionmentioning

confidence: 99%

Physician-Targeted Interventions in Antibiotic Prescribing for Urinary Tract Infections in General Practice: A Systematic Review

et al. 2022

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Urinary tract infections (UTIs) are the most common reason for women to consult a general practitioner (GP). While UTIs are self-limiting in half of cases, most women are prescribed antibiotics, often in discordance with established guidelines. Researchers have employed different interventions to improve GPs’ prescribing behavior, especially for respiratory infections, but it is uncertain whether these are effective for UTI care. Therefore, we performed a systematic review, including (cluster) randomized clinical trials investigating the effect of interventions targeted at GPs to improve antibiotic prescriptions for UTI. From September to December 2021 we searched the Medline, Web of Science, and CENTRAL databases, ultimately including ten studies describing eleven trials. We determined the effect of the interventions on the decision to prescribe and on the choice of antibiotic. Results showed that most studies employed multifaceted interventions, most frequently including audit & feedback and/or educational meetings. Seven out of nine trials that recorded first-choice prescriptions saw an increased proportion of first-choice antibiotics in the intervention groups compared to control groups. The employed interventions also caused a decreased proportion of at least one broad-spectrum antibiotic in five out of six studies that measured broad-spectrum antibiotic prescriptions. However, the total number of antibiotic prescriptions for UTIs increased in four out of eight studies. Therefore, while effective at influencing GPs’ prescribing behavior, future interventions should also focus on improving the decision to prescribe at all.

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“…The therapeutic approach in this group focuses on prevention and self-management [ 2 ], with typical strategies including behavioral modification and both non-antimicrobial and antimicrobial prophylaxis [ 3 ]. A recent qualitative study among women with rUTI indicated marked variation in their knowledge of preventive measures [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Development and feasibility of a telemedicine tool for patients with recurrent urinary tract infection: myRUTIcoach

Pat,

Pape,

Steffens

et al. 2023

Int Urogynecol J

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Introduction and hypothesis Patients with recurrent urinary tract infection (rUTI) have limited knowledge of preventive strategies to lower the risk of UTI. We aimed to develop and test the feasibility of an eHealth system for women with rUTI, named myRUTIcoach, and explored the facilitators and barriers related to its adoption. Methods We developed myRUTIcoach in a structured iterative process and tested its feasibility among 25 women with rUTI over 2 months. Subsequent questionnaires covered satisfaction, accessibility, and experiences with myRUTIcoach. A random selection of participants and relevant stakeholders took part in semi-structured interviews to explore adoption. Data were analyzed and elaborated using inductive and deductive approaches using the Non-adoption, Abandonment, Spread, Scale-up, and Sustainability (NASSS) framework. Results MyRUTIcoach was not only widely accepted but also facilitated communication with health care professionals (HCPs) and contributed to greater knowledge of rUTI. Women graded the system a mean of 8.0 (±0.6) out of 10, with 89% stating that they would recommend it to others. Patients indicated that self-management skills were the major facilitators and barriers related to adoption, whereas HCPs stated that the disconnect between myRUTIcoach and electronic health care records (EHRs) was the major barrier. Conclusions This research describes the development and testing of myRUTIcoach for women with rUTI. Patients and HCPs reported high satisfaction and compliance with myRUTIcoach. However, adoption by the intended users is complex and influenced by all examined domains of the NASSS framework. We have already improved linkage to EHRs, but further optimization to meet patient needs may improve the effectiveness of this self-management tool for rUTI.

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Adherence to guideline recommendations for urinary tract infections in adult women: a cross-sectional study

Cited by 7 publications

References 27 publications

Characteristics Associated With Repeated Evaluations for Urinary Tract Infections in Older Women: A Case-Control Study

Characteristics Associated With Repeated Evaluations for Urinary Tract Infections in Older Women: A Case-Control Study

Physician-Targeted Interventions in Antibiotic Prescribing for Urinary Tract Infections in General Practice: A Systematic Review

Development and feasibility of a telemedicine tool for patients with recurrent urinary tract infection: myRUTIcoach

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