Urology outpatient antibiotic use may be ‘substantially underestimated’
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Key takeaways:
- Of a total of 54,410 prescriptions analyzed, 46% were for single-dose antibiotics and 48% for 1- to 28-day prescriptions.
- Overall, 72.3% of the 1- to 28-day prescriptions were given during nonvisit encounters.
HOUSTON — Antibiotic use in urology outpatient settings may be “substantially underestimated” if only prescriptions made during in-person encounters are considered, researchers found.
“We were seeing increasing number of referrals from urology clinics of patients with recurrent UTIs, and with multidrug-resistant organisms, especially extended-spectrum beta lactamase or (ESBL) producing organisms,” Sonal S. Munsiff, MD, associate professor in the department of medicine at the University of Rochester told Healio. “In addition, data from an ongoing surveillance project showed that most ESBL producing organisms in our area were from urinary sources and were isolated from specimens collected in the ambulatory setting rather than from hospital admissions.”
Munsiff added, “We therefore reached out to our urology department colleagues to identify education needs and develop interventions.”
The researchers focused their analysis, which was presented at the Society for Healthcare Epidemiology of America Spring conference, on antibiotic prescribing trends in adults during both visit and nonvisit — such as telephone and chart messages — across 15 ambulatory urology clinics. Prescriptions were categorized into single doses administered in the clinic and those prescribed for 1 to 28 days.
A total of 54,410 prescriptions were analyzed over the 4-year period between 2018 and 2021, with exclusions made for antivirals, antiparasitics, antifungals, oral suspensions, selected non-UTI antibiotics, duplicate orders on the same day or week, and prescriptions exceeding 28 days.
Of these, nearly half (47%; n = 26,944) were for single doses given during an in-office visit for preprocedure prophylaxis. The most commonly prescribed antibiotics for prophylaxis were fluoroquinolones (47.5%), followed by ceftriaxone (19.2%), nitrofurantoin (13.2%), trimethoprim/sulfamethoxazole (8.6%) and gentamicin (4.2%).
Among the 27,288 (48%) prescriptions given for 1 to 28 days, 72.3% were from nonvisit encounters.
“We believe that this is the highest rate of antibiotic prescribing without an office or virtual visit that we have seen in the literature,” Munsiff said.
Of these, 61.6% were prescribed by advanced practice providers (APPs), with the average number of prescriptions per patient being 2.07, and women (82%) receiving more prescriptions than men (64%). Among these patients, fluoroquinolones remained the most prescribed antibiotics during all encounters (23.7%) but were followed closely by nitrofurantoin (23%).
The researchers added that antibiotic duration was longer for visit-based compared with nonvisit-based prescriptions (10 vs. 7 days; P < .001). Munsiff explained that this longer duration often reflected default durations that are set in electronic health records for the specific drugs.
Based on these findings, Munsiff said that the study shows that antibiotic use in urology outpatient settings is “substantially underestimated” if only prescriptions made during visit encounters are considered.
“Given that the majority of antibiotic prescriptions in these clinics were made by APPs, provider education interventions should focus on APPs,” Munsiff said. “We can address antibiotic durations prescribed by changing default durations in electronic orders to reflect guideline recommendations.”
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Munsiff S, et al. Abstract 205. Presented at: Society for Healthcare Epidemiology of America Spring Conference; April 16-19; Houston.
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