The Effect of Sociodemographic Factors, Parity and Cervical Cancer on Antibiotic Treatment for Uncomplicated Cystitis in Women: A Nationwide Cohort Study

Jansåker, Filip; Li, Xinjun; Knudsen, Jenny Dahl; Nymberg, Veronica Milos; Sundquist, Kristina

doi:10.3390/antibiotics10111389

Cited by 4 publications

(17 citation statements)

References 28 publications

(86 reference statements)

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“…For country of origin, only MENA women had lower odds of fluoroquinolone compared to Swedish-born women (although statistically non-significant), while women from Asia (excluding Middle East) and Oceania, Western countries, and Latin America and the Caribbean had weak but significantly higher odds of fluoroquinolone treatment compared to Swedish-born women. The mechanisms behind these sociodemographic differences in fluoroquinolone treatment of uncomplicated cystitis, which were similar to the odds for antibiotic treatment in general [ 4 ], could, inter alia, be attributed to uncertainty in diagnostic testing [ 18 ]. During the last decade, it has not been recommended to prescribe fluoroquinolones as a first-line prescription for uncomplicated cystitis [ 19 ], as these antibiotics ought to be limited to serious infections and not uncomplicated cystitis due to concern of worrisome collateral damage and adverse effects associated with these antibiotics [ 15 , 16 , 17 , 18 , 19 , 20 ].…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, no firm conclusion can be made on whether the differences in fluoroquinolone treatment could have been due to unequal healthcare (differences in prescription rates) or differences in adherence (differences in pick-up rates). Further studies could examine possible mechanisms behind the found associations of factors likely beyond the infection and antibiotic treatments [ 4 ]. The main strengths of this study include that this study involved several highly validated nationwide patient and population data registries including nationwide primary healthcare data.…”

Section: Discussionmentioning

confidence: 99%

“…Uncomplicated lower urinary tract infection (UTI), also known as uncomplicated cystitis, is one of the most common bacterial infections in women. About one in ten women have at least one infection each year and therefore cystitis is an important contributor to antibiotics exposure in otherwise healthy women in Sweden and worldwide [ 1 , 2 , 3 , 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

“…We recently identified that about 54.5% of women diagnosed with uncomplicated cystitis in Sweden redeemed an antibiotic for their prescription. Furthermore, the study found that certain factors (likely beyond the infection) were associated with antibiotic treatment for cystitis [ 4 ]. In this follow-up study, by using a similar method [ 4 ], we aimed to study what specific classes of antibiotics were redeemed for cystitis in Sweden over a 13-year time period and determine if the annual trends were similar to the national surveillance program of antibiotics.…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, the study found that certain factors (likely beyond the infection) were associated with antibiotic treatment for cystitis [ 4 ]. In this follow-up study, by using a similar method [ 4 ], we aimed to study what specific classes of antibiotics were redeemed for cystitis in Sweden over a 13-year time period and determine if the annual trends were similar to the national surveillance program of antibiotics. We also intended to study if factors likely beyond the infection (e.g., history of cervical cancer and parity, and sociodemographic factors) could be associated with fluoroquinolone treatment.…”

Section: Introductionmentioning

confidence: 99%

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Fluoroquinolones and Other Antibiotics Redeemed for Cystitis—A Swedish Nationwide Cohort Follow-Up Study (2006–2018)

Sundquist

Jansåker

2022

Antibiotics

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Background: Antibiotics are commonly prescribed for outpatient management of cystitis. Previous evidence suggests that certain factors likely beyond the infection seem to influence the choice of antimicrobial treatment. However, studies on the specific antibiotic treatments for cystitis are lacking. This study aimed to explore the antibiotic treatments for cystitis using nationwide primary healthcare data and investigate if factors beyond the infection could be associated with fluoroquinolone treatment. Methods: This nationwide follow-up cohort study consisted of 352,507 women with cystitis. The primary aim was to investigate what specific classes of antibiotics were redeemed by patients within five days from the cystitis diagnosis. Each patient could only be included once. Logistic regression models were also used to examine the relationship between fluoroquinolone (FQ) treatment, parity, and sociodemographic factors. Results: In total, 192,065 antibiotic prescriptions were redeemed. Pivmecillinam (58.4%) followed by nitrofurantoin (22.2%), trimethoprim (12.0%), fluoroquinolone (5.6%), and cephalosporins (1.5%) were the most redeemed antibiotics. Sociodemographic factors were weakly associated with fluoroquinolone treatment; young age was inversely associated with fluoroquinolone treatment. Parity and cervical cancer history were not associated with fluoroquinolone treatment. The proportion of fluoroquinolone and trimethoprim treatments decreased over time, while pivmecillinam and nitrofurantoin increased. Conclusions: The treatment trends of antibiotics redeemed within five days from a cystitis diagnosis were similar to the national surveillance program of these antibiotics (not diagnosis linked). Fluoroquinolones were weakly associated with sociodemographic factors, which likely is only of historical relevance.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Fluoroquinolones and Other Antibiotics Redeemed for Cystitis—A Swedish Nationwide Cohort Follow-Up Study (2006–2018)

Sundquist

Jansåker

2022

Antibiotics

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The association between bacteriuria and adverse pregnancy outcomes: a systematic review and meta-analysis of observational studies

Piazzolla,

Modin,

Halkjær

et al. 2023

Journal of Antimicrobial Chemotherapy

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Background Antibiotics for bacteriuria and urinary tract infection are commonly prescribed during pregnancy to avoid adverse pregnancy outcomes. The aim of this study was to evaluate the association between significant bacteriuria in pregnancy and any of the four pregnancy outcomes: preterm delivery; low birth weight; small for gestational age; and preterm labour. Methods Systematic review with meta-analysis of observational studies. We searched PubMed, EMBASE, the Cochrane CENTRAL library, and Web of Science for observational studies published before 1 March 2022. The risk of bias was assessed using the Newcastle–Ottawa scale. Study identification, data extraction and risk-of-bias assessment was performed by two independent authors. We combined the included studies in meta-analyses and expressed results as ORs with 95% CIs (Prospero CRD42016053485). Results We identified 58 studies involving 421 657 women. The quality of the studies was mainly poor or fair. The pooled, unadjusted OR for the association between any significant bacteriuria and: (i) preterm delivery was 1.62 (95% CI: 1.30–2.01; 27 studies; I2 = 61%); (ii) low birth weight was 1.50 (95% CI: 1.30–1.72; 47 studies; I2 = 74%); (iii) preterm labour was 2.29 (95% CI: 1.53–3.43; 3 studies; I2 = 0%); and (iv) small for gestational age was 1.33 (95% CI: 0.88–2.02; 7 studies; I2 = 54%). Four studies provided an adjusted OR, but were too diverse to combine in meta-analysis. Conclusions This systematic review identified an association between significant bacteriuria in pregnancy and the three complications: preterm delivery; low birth weight; and preterm labour. However, the quality of the available evidence is insufficient to conclude whether this association is merely due to confounding factors. There is a lack of high-quality evidence to support active identification and treatment of bacteriuria in pregnancy.

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The Risk of Pyelonephritis Following Uncomplicated Cystitis: A Nationwide Primary Healthcare Study

Jansåker

Vik

et al. 2022

Antibiotics

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Background: The risk of pyelonephritis following uncomplicated lower urinary tract infection (cystitis) in women has not been studied in well-powered samples. This is likely due to the previous lack of nationwide primary healthcare data. We aimed to examine the risks of pyelonephritis following cystitis in women and explore if antibiotic treatment, cervical cancer, parity, and sociodemographic factors are related to these risks. Methods: This was a nationwide cohort study (2006–2018) of 752,289 women diagnosed with uncomplicated cystitis in primary healthcare settings. Of these, 404 696 did not redeem an antibiotic prescription within five days from cystitis. Logistic regression models were used to calculate odds ratios for pyelonephritis within 30 days and 90 days following the cystitis event. Results: Around one percent (7454) of all women with cystitis were diagnosed with pyelonephritis within 30 days, of which 78.2% had not redeemed an antibiotic for their cystitis. Antibiotic treatment was inversely associated with both outpatient registration and hospitalization due to pyelonephritis, with odds ratios of 0.85 (95% CI 0.80 to 0.91) and 0.65 (95% CI 0.55 to 0.77), respectively. Sociodemographic factors, parity, and cervical cancer were, with few exceptions (e.g., age and region of residency), not associated with pyelonephritis. Conclusions: Antibiotic treatment was inversely associated with pyelonephritis, but the absolute risk reduction was low. Non-antibiotic treatment for cystitis might be a safe option for most women. Future studies identifying the women at the highest risks will help clinicians in their decision making when treating cystitis, while keeping the ecological costs of antibiotics in mind.

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The Effect of Sociodemographic Factors, Parity and Cervical Cancer on Antibiotic Treatment for Uncomplicated Cystitis in Women: A Nationwide Cohort Study

Cited by 4 publications

References 28 publications

Fluoroquinolones and Other Antibiotics Redeemed for Cystitis—A Swedish Nationwide Cohort Follow-Up Study (2006–2018)

Fluoroquinolones and Other Antibiotics Redeemed for Cystitis—A Swedish Nationwide Cohort Follow-Up Study (2006–2018)

The association between bacteriuria and adverse pregnancy outcomes: a systematic review and meta-analysis of observational studies

The Risk of Pyelonephritis Following Uncomplicated Cystitis: A Nationwide Primary Healthcare Study

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