Infectious Disease

Prescribing recurrent UTIs often does not conform to IDSA guidelines

April 16, 2021

2 min read

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Valentine-King MA et al. Analysis of the management of recurrent urinary tract infections in outpatient settings reveals opportunities for antibiotic stewardship interventions. Presented at: SHEA Spring Conference; 13-16 April 2021 (virtual meeting).

Disclosure:
Valentine-King reports that it has received assistance from the Health Resources and Services Administration, an agency of HHS.

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An evaluation of antibiotic prescribing practices in adult patients with uncomplicated, recurring urinary tract infections found that prescriptions often inconsistent with guidelines from the Infectious Diseases Society of America, researchers reported.

Marissa Valentine-King, PhD, MPH, BSN, A postdoctoral fellow in primary care at Baylor College of Medicine reported results from a study of nearly 600 outpatient visits at the SHEA Spring Conference.

Recurring UTI infographic

Source: Valentine-King MA et al. Analysis of the management of recurrent urinary tract infections in outpatient settings reveals opportunities for antibiotic stewardship interventions. Presented at: SHEA Spring Conference; 13-16 April 2021 (virtual meeting).

“Prescribing patterns in patients with relapsed UTIs is an under-researched area,” Valentine-King told Healio, adding that treatment guidelines in the literature for relapsing UTIs “largely follow” IDSA recommendations for uncomplicated UTIs.

“Previous studies examining treatment patterns in sporadic urinary tract infections related to the prescription of fluroquinolone are of concern because they are associated with Clostridium difficile colitis and have central nervous system, cardiovascular and musculoskeletal side effects “, she said. “In addition, these studies found that most prescriptions exceeded the duration of therapy recommended by the IDSA. As patients with recurrent urinary tract infections are exposed to increased exposure to antibiotics, there is an urgent need to establish basic information on prescribing practices in this population. “

Marissa Valentine-King

Between November 2016 and December 2018, Valentine-King and colleagues conducted a retrospective observational study of electronic health data from adults studied in primary care, internal medicine, or urology to analyze recurrent urinary tract infections in outpatient settings. The study included 232 predominantly female patients who made 597 outpatient visits for uncomplicated, recurring UTIs.

According to Valentine-King and colleagues, only 21% of prescriptions were from a first-line agent for the recommended length of time under IDSA’s guidelines for uncomplicated urinary tract infections. Valentine-King explained that first-line actives made up 58.4% of prescriptions and nearly a third (28.8%) of prescriptions contained fluoroquinolones that did not meet guidelines.

In addition, more than 85% of fluoroquinolones, 70% of trimethoprim-sulfamethoxazole, and 60% of nitrofurantoin prescriptions have exceeded the recommended duration of therapy, Valentine-King explained. The researchers also found that only 52% of recurring UTI visits included a urine culture sequence. This is recommended practice backed up by recurring UTI guidelines published by the American Urological Association.

Being male, attending a urology practice, and having recurrent urinary tract infections more frequently during the study was associated with longer duration of therapy, while older age and phone calls were associated with prescribing a beta-lactam, the researchers reported.

“Our study shows that prescribing antibiotics related to recurrent urinary tract infections serves as a target for antibiotic management,” said Valentine-King.

She said the study’s co-authors conducted a multi-layered stewardship intervention in their facility’s outpatient setting that doubled compliance with IDSA guidelines in patients with intermittent urinary tract infections. More research into why prescribing deviates from guidelines is needed to address these issues, she added.

“Similar to patients with intermittent urinary tract infections, antibiotic prescribing for patients with recurrent urinary tract infections shows poor compliance with IDSA guidelines, further predisposing this population to the adverse effects of inappropriate prescribing,” said Valentine-King. “Providers should use company guidelines to ensure that prescribing is based on the best evidence available.”

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SHEA Spring Conference

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