Antibiotic Prescribing Patterns and Guideline Concordance for Uncomplicated Urinary Tract Infections Among Adult Women in the US Military Health System

Abstract

IMPORTANCEUrinary tract infections (UTIs) are one of the most commonly diagnosed infections, and prior studies have reported discordance in antibiotic treatment with the Infectious Diseases Society of America (IDSA) guidelines. OBJECTIVE To assess IDSA guideline concordance rates for women with uncomplicated UTIs treated with antibiotics, and compare concordance rates between different specialty field. DESIGN, SETTING, AND PARTICIPANTS Retrospective cross-sectional study of health care claims data from the US Military Health System Data Repository, which contains comprehensive health care encounter and claims data for all military beneficiaries. Participants were adult women between the ages of 18 to 50 years with uncomplicated UTIs from October 1, 2017, to September 30, 2019. Data extraction and analysis were performed in 2022. Patients with diagnosis of UTI in the preceding 6 months, current pregnancy, history of pyelonephritis, history of diabetes, history of organ transplant, history of human immunodeficiency virus, immunosuppression, renal insufficiency, urinary tract abnormalities, or history of urologic procedures were excluded. EXPOSURES Antibiotic treatment for uncomplicated UTIs. Only antibiotics received within 1 day after the diagnosis were analyzed. The IDSA recommends the following antibiotics as first-line therapy: nitrofurantoin, trimethoprim-sulfamethoxazole, fosfomycin, pivmecillinam. MAIN OUTCOMES AND MEASURES The IDSA guideline concordance rates were calculated as the number of patients receiving first-line antibiotic therapy divided by the total number of cases for uncomplicated UTIs. RESULTS A total of 46 793 adult women (67.3% [31 475 of 46 793] aged 18-34 years; 38.2% [31 475 of 46 793] of White race) were diagnosed with uncomplicated UTIs with 91.0% receiving guidelineconcordant antibiotic treatment. In comparison with obstetrics and gynecology, IDSA guidelineconcordant treatment was more likely in internal medicine (adjusted odds ratio [aOR], 2.87; 95% CI,

Unmet needs in uncomplicated urinary tract infection in the United States and Germany: a physician survey

“…Such misunderstandings can often be explained by a lack of effective communication between the patient and the physician [ 10 , 11 ]. Previous surveys have found that physicians vary in their approach to the management of uUTI [ 4 ] and that the specialty of the prescribing physician may influence prescribing patterns [ 12 ]. As such, understanding the perspectives of physicians from diverse healthcare systems is important for developing effective treatment strategies.…”

Exploring variations in recommended first‐choice therapy for complicated urinary tract infections in males: Insights from outpatient settings across age, race, and ethnicity

“…Similar to our findings, among a cohort of outpatient males with UTI, race was not associated with antibiotic choice or treatment duration 27 . In women, there have been conflicting reports regarding racial disparities in the treatment of uncomplicated UTIs 39–41 . One study among 46,793 women diagnosed with an uncomplicated UTI in the United States found higher rates of treatment concordance with the Infectious Diseases Society of America treatment guidelines in Black women (aOR, 1.04; 95% CI 1.03–1.05) as compared with White women 41 …”

“…27 In women, there have been conflicting reports regarding racial disparities in the treatment of uncomplicated UTIs. [39][40][41] One study among 46,793 women diagnosed with an uncomplicated UTI in the United States found higher rates of treatment concordance with the Infectious Diseases Society of America treatment guidelines in Black women (aOR, 1.04; 95% CI 1.03-1.05) as compared with White women. 41 Although we did not observe any disparities in recommended first-choice therapy by race or ethnicity, there may still be differences in the treatment and outcomes of complicated UTIs among males that we did not assess in our study, including disparities stemming from implicit provider bias which leads to systemic and pervasive differences in care.…”

Treatment Patterns and Adherence to Guidelines for Uncomplicated Urinary Tract Infection in Germany: A Retrospective Cohort Study

“…The various medical specialties involved in uUTI management, including urologists, gynecologists, and family and internal medicine physicians, demonstrate different approaches to treatment and varying levels of concordance with guidelines [ 6 ]. Treatment decisions that do not align with guidelines can be driven by low levels of reliance on guidelines, but can also occur when physicians alter their antibiotic prescribing (i.e., longer duration and/or broader spectrum) to account for patient factors such as older age, presence of diabetes, and urinary tract infection (UTI) recurrence [ 7 ].…”