Prescribing for recurrent UTIs often does not align with IDSA guidelines, study finds
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An assessment of antibiotic prescribing practices for adult patients with uncomplicated, recurring UTIs showed that prescriptions often do not align with Infectious Diseases Society of America guidelines, researchers reported.
Marissa Valentine-King, PhD, MPH, BSN, a postdoctoral research fellow in primary care at Baylor College of Medicine, reported findings at the SHEA Spring Conference from a study of almost 600 outpatient visits.
“Prescribing patterns among patients with recurrent UTIs is an understudied area,” Valentine-King told Healio, adding that treatment guidelines in the literature for recurrent UTIs “largely follow” IDSA recommendations for uncomplicated UTIs.
“Prior studies that investigated treatment patterns among sporadic UTIs found concerning levels of fluroquinolone prescribing, a worrisome finding due to their association with Clostridium difficile colitis and adverse effects impacting the central nervous, cardiovascular and musculoskeletal systems,” she said. “Further, these studies also found the majority of prescriptions exceeded the IDSA’s recommended duration of therapy. As patients with recurrent UTI experience increased exposure to antibiotics, there is a critical need to establish baseline information on prescribing practices in this population.”
Valentine-King and colleagues performed an observational, retrospective study using electronic health data from adults seen at academic primary care, internal medicine, or urology practices between November 2016 through December 2018 to analyze recurrent UTI treatment in outpatient settings. The study included 232 mostly female patients who made 597 outpatient visits for uncomplicated, recurrent UTIs.
According to Valentine-King and colleagues, only 21% of prescriptions consisted of a first-line agent for the recommended duration, per IDSA guidelines for uncomplicated UTI. Valentine-King elaborated, saying that first-line agents composed 58.4% of prescriptions, and nearly a third (28.8%) of prescriptions were for guideline-discordant fluoroquinolones.
Additionally, more than 85% of fluoroquinolones, 70% of trimethoprim-sulfamethoxazole and 60% of nitrofurantoin prescriptions exceeded the recommended length of therapy, Valentine-King explained. The researchers also found that only 52% of recurrent UTI visits included a urine culture order, which is the recommended practice endorsed by recurrent UTI guidelines published by the American Urological Association.
Being male, visiting a urology practice and having a higher frequency of recurrent UTIs during the study were associated with increased duration of therapy, whereas older age and having a telephone visit was associated with having a beta-lactam prescribed, the researchers reported.
“Our study illustrates antibiotic prescribing in the context of recurrent UTI serves as a target for antibiotic stewardship,” Valentine-King said.
She said co-authors of the study have implemented a multifaceted stewardship intervention in the outpatient setting at their institution that doubled concordance with IDSA guidelines among patients with sporadic UTI. Further research exploring why prescribing diverges from guidelines is needed to address these topics, she added.
“Similar to patients with sporadic UTI, antibiotic prescribing in patients with recurrent UTI shows low concordance with IDSA guidelines, further predisposing this population to adverse effects from inappropriate prescribing,” Valentine-King said. “Providers should utilize society guidelines to ensure prescribing aligns with the best available evidence.”
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Valentine-King MA, et al. Analysis of recurrent urinary tract infection management in outpatient settings reveals opportunities for antibiotic stewardship interventions. Presented at: SHEA Spring Conference; April 13-16, 2021 (virtual meeting).
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