Assessing Adherence to Evidence-Based Guidelines for the Diagnosis and Management of Uncomplicated Urinary Tract Infection

Grover, Michael; Bracamonte, Jesse D.; Kanodia, Anup K.; Bryan, Michael; Donahue, Sean P.; Warner, Anne Marie; Edwards, Frederick D.; Weaver, Amy L.

doi:10.4065/82.2.181

Cited by 32 publications

(22 citation statements)

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“…The Infectious Diseases Society of America has recommended that when resistance to TMP-SMX is greater than 10 to 20%, TMP-SMX should not be used as first-line empirical therapy (19). As this study shows a resistance level of 29.6%, which is higher than levels from recent studies (2,8,20), TMP-SMX is no longer ideal for first-line therapy.…”

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confidence: 51%

Antibiotic Resistance in Urinary Isolates of Escherichia coli from College Women with Urinary Tract Infections

Olson

Harrell

Kaye

2009

Antimicrob Agents Chemother

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Of 176 urine isolates from female students positive for Escherichia coli, 29.6% were trimethoprim-sulfamethoxazole resistant and none were nitrofurantoin resistant. Among students with a history of urinary tract infection (UTI) (n ‫؍‬ 119), resistance to ciprofloxacin was 11.8%, compared to 1.8% among those without prior UTI. Nitrofurantoin should be considered for empirical therapy of lower tract UTI.Urinary tract infections (UTIs) are a common cause of morbidity in women (7). The majority of cases involve only the lower urinary tract, and the most common pathogen is Escherichia coli (9, 21). For uncomplicated infections, especially those without signs of upper tract infection, empirical therapy without culture and susceptibility analysis are recommended (3,4,19). Resistance to amoxicillin has been established for years, and resistance to trimethoprim-sulfamethoxazole (TMP-SMX) has emerged more recently, with rates of Ͼ20% in some areas (9). The Infectious Diseases Society of America recommends that in regions where resistance rates to TMP-SMX exceed 10% to 20%, TMP-SMX should not be used for empirical therapy (19). Fluoroquinolones, in particular ciprofloxacin, are used increasingly (10, 11), but resistance to ciprofloxacin is also increasing (12,15).College women have a high incidence of uncomplicated UTIs and are frequently treated empirically. Unfortunately, since studies of resistance patterns include mostly complicated UTIs in older women (9, 21), resistance may develop undetected among college students with lower tract UTIs.The objective of this analysis was to determine resistance patterns among E. coli isolates from young women with UTIs in a college setting in the southeastern United States.All urine isolates in this study were processed at the Duke University Clinical Microbiology Laboratory. The records of female students presenting to a university student health clinic with symptoms of UTI and who had urine culture and sensitivity results positive for E. coli were examined retrospectively. The susceptibilities to common antibiotics were analyzed and compared to those for all urinary E. coli isolates, as described in the antibiogram of the health system clinical microbiology laboratory. The clinical records were analyzed for the following variables: age, presence of a urinary anomaly, presence of upper UTI symptoms (fever or flank pain), and history of previous UTI.Statistical analysis was performed using the chi-square test and the Fisher exact test for dichotomous variables.Over the three calendar years 2005 to 2007, in the entire health system, there were 10,289 urinary isolates positive for E. coli, which were analyzed for antibiotic susceptibilities. One hundred seventy-six isolates of culture-positive UTI were obtained from 167 female patients presenting to the student health clinic. The average age (Ϯ standard deviation) was 22.0 (Ϯ6.2) years. Ampicillin resistance occurred in 3,857 (37.5%) of the health system isolates and 65 (37%) of the students (P ϭ 0.88). TMP-SMX resistance occurred in 2...

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confidence: 51%

Antibiotic Resistance in Urinary Isolates of Escherichia coli from College Women with Urinary Tract Infections

Olson

Harrell

Kaye

2009

Antimicrob Agents Chemother

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“…In this secondary analysis, we compared both elder patient groups' data to findings from the uncomplicated UTI group. 5 Trends in rates across the 3 groups (ordered by advancing age then complications) were evaluated using the Cochran-Armitage trend test. Otherwise, 2-group comparisons were evaluated based on the 2 test.…”

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confidence: 99%

“…3 We were interested to know if our older female patients might have differing UTI pathogens or increased rates of E. coli antibiotic resistance and if our physicians managed them in a manner similar or dissimilar to the care provided to the younger, uncomplicated patients from our previous report. 5 The objectives of this study were to evaluate the care of women who were age 65 or older who presented to our office with UTI symptoms and to determine (1) the antibiotic treatments provided and their durations; (2) the frequency of E. coli versus other bacteria found on UC&S testing; and (3) the frequency with which it was necessary to change antibiotic treatments based on UC&S results.…”

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confidence: 99%

“…We previously reported that in young, uncomplicated patients we used SMX/TMP in 26 of the 68 patients (38%). 5 In uncomplicated elder patients, SMX/TMP was used in 14 (24%) compared with 7 (17%) of complicated elder patients. There was a significant trend among physicians to be less likely to prescribe TMP/SMX to patients with advancing age and complications across all 3 groups (P ϭ .011).…”

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confidence: 99%

“…5 At our community-based, university-affiliated residency site, only 30% of patients had an uncomplicated UTI (ie, they were young and had no complicating features) and were considered eligible for treatment using evidence-based practice guidelines. These guidelines place emphasis on empiric treatment with sulfamethoxazole-trimethoprim (SMX/ TMP) without urine culture and sensitivity testing (UC&S).…”

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Urinary Tract Infection in Women Over the Age of 65: Is Age Alone a Marker of Complication?

Grover¹,

Bracamonte²,

Kanodia³

et al. 2009

The Journal of the American Board of Family Medicine

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Background:We were interested to know if our older female patients with urinary tract infections (UTIs) might have differing pathogens or rates of Escherichia coli antibiotic sensitivity and if our physicians managed them in a manner similar or dissimilar to the care provided to younger patients with no complications.Methods: This was a secondary analysis from patients excluded from a previous retrospective study regarding uncomplicated UTIs.Results: Twenty-six percent of total patients with UTIs were older than 65 and otherwise medically uncomplicated whereas 21% were older patients who did have complicating factors. E. coli was a pathogen in 81% of uncomplicated elders' and 54% of complicated elders' cultures. E. coli sensitivity rate to sulfamethoxazole-trimethoprim (SMX/TMP) in both groups was 86%. Physicians were significantly less likely to prescribe SMX/TMP for complicated older patients with complications than for young patients with an uncomplicated UTI (P ‫؍‬ .017); there was a significant trend of physicians to be less likely to prescribe SMX/TMP with advancing age in a patient and complications across all 3 groups (P ‫؍‬ .011). Antibiotics rarely needed to be changed after cultures.Conclusions: The presence of E. coli on culture in patients with a UTI changes based on medical complications, not age. Being medically complex did not result in reduced sensitivity of E. coli to SMX/ TMP but was associated with increased rates of the presence of other pathogens. In our setting, treatment employed with SMX/TMP and without the use of culture and sensitivity may be effective for appropriately selected older women. Prospective studies are needed to determine the optimal approach to management.

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Urinary Tract Infections

Fekete¹

2018

Evidence‐Based Infectious Diseases

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Assessing Adherence to Evidence-Based Guidelines for the Diagnosis and Management of Uncomplicated Urinary Tract Infection

Cited by 32 publications

References 10 publications

Antibiotic Resistance in Urinary Isolates of Escherichia coli from College Women with Urinary Tract Infections

Antibiotic Resistance in Urinary Isolates of Escherichia coli from College Women with Urinary Tract Infections

Urinary Tract Infection in Women Over the Age of 65: Is Age Alone a Marker of Complication?

Urinary Tract Infections

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