A Descriptive Analysis of Outpatient Antimicrobial Use for Urinary Tract Infections in Virginia

Background: Data regarding outpatient antibiotic prescribing for urinary tract infections (UTIs) are limited, and they have never been formally summarized in Virginia. Objective: We describe outpatient antibiotic prescribing trends for UTIs based on gender, age, geographic region, insurance payer and International Classification of Disease, Tenth Revision (ICD-10) codes in Virginia. Methods: We used the Virginia All-Payer Claims Database (APCD), administered by Virginia Health Information (VHI), which holds data for Medicare, Medicaid, and private insurance. The study cohort included Virginia residents who had a primary diagnosis of UTI, had an antibiotic claim 0–3 days after the date of the diagnosis and who were seen in an outpatient facility in Virginia between January 1, 2016, and December 31, 2016. A diagnosis of UTI was categorized as cystitis, urethritis or pyelonephritis and was defined using the following ICD-10 codes: N30.0, N30.00, N30.01, N30.9, N30.90, N30.91, N39.0, N34.1, N34.2, and N10. The following antibiotics were prescribed: aminoglycosides, sulfamethoxazole/trimethoprim (TMP-SMX), cephalosporins, fluoroquinolones, macrolides, penicillins, tetracyclines, or nitrofurantoin. Patients were categorized based on gender, age, location, insurance payer and UTI type. We used χ2 and Cochran-Mantel-Haenszel testing. Analyses were performed in SAS version 9.4 software (SAS Institute, Cary, NC). Results: In total, 15,580 patients were included in this study. Prescriptions for antibiotics by drug class differed significantly by gender (P < .0001), age (P < .0001), geographic region (P < .0001), insurance payer (P < .0001), and UTI type (P < .0001). Cephalosporins were prescribed more often to women (32.48%, 4,173 of 12,846) than to men (26.26%, 718 of 2,734), and fluoroquinolones were prescribed more often to men (53.88%, 1,473 of 2,734) than to women (47.91%, 6,155 of 12,846). Although cephalosporins were prescribed most frequently (42.58%, 557 of 1,308) in northern Virginia, fluoroquinolones were prescribed the most in eastern Virginia (50.76%, 1677 of 3,304). Patients with commercial health insurance, Medicaid, and Medicare were prescribed fluoroquinolones (39.31%, 1,149 of 2,923), cephalosporins (56.33%, 1,326 of 2,354), and fluoroquinolones (57.36%, 5,910 of 10,303) most frequently, respectively. Conclusions: Antibiotic prescribing trends for UTIs varied by gender, age, geographic region, payer status and UTI type in the state of Virginia. These data will inform future statewide antimicrobial stewardship efforts.Funding: NoneDisclosures: Michelle Doll reports a research grant from Molnlycke Healthcare.

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Susceptibility Trends of Urinary Tract Infections Over a 15 Year Period on a University Campus

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.830 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S346-S347

Author(s):

Wesley Hoffmann ◽

Monica Donnelley ◽

Thomas Ferguson

Keyword(s):

Urinary Tract ◽

Urinary Tract Infections ◽

Antibiotic Prescribing ◽

Prescribing Practices ◽

Acute Cystitis ◽

E Coli ◽

First Line Therapy ◽

Time Period ◽

Prescribing Trends ◽

Tract Infections

Abstract Background Acute uncomplicated cystitis (AUC) is one of the most common infections for which antimicrobials are prescribed. Despite IDSA AUC guideline recommendations, prescribing practices are varied throughout the US. Per IDSA recommendations, nitrofurantoin (NTF), fosfomycin, and trimethoprim/sulfamethoxazole (TMP/SMX) are all considered first line therapy for AUC, however there is concern of resistance to some of these agents. Quality improvement activity at the University of California, Davis Student Health Center (UCDSHC) has made prescribing NTF preferred for acute cystitis since 2001 as TMP/SMX has community resistance rates of ~20%. Ciprofloxacin is the second line agent at UCDSHC. Methods UCDSHC reviewed all urine cultures and susceptibilities for clinical and epidemiologic purposes. Susceptibility results were gathered from the UCDSHC microbiology laboratory from 2001–2016. Prescribing data was obtained from UCDSHC under diagnosis codes consistent with cystitis or UTI to demonstrate antibiotic prescribing trends. Susceptibilities were evaluated over the 15-year time period (2001–2016). TMP/SMX, FQ’s, and NTF were the primary agents evaluated in this study. Results From 2001–2016, 3,831 E. coli and 296 S. saprophyticus isolates were evaluated, accounting for 88% of the total number of organisms. E. coli susceptibilities to NTF remained >98% from 2001–2016. E. coli susceptibilities to FQ’s trended down from 99% in 2001 to 88% in 2016. E. coli susceptibilities to TMP/SMX remained stable around 80% from 2001–2016. S. saprophyticusremained highly susceptible to NTF, FQ’s, and TMP/SMX (95%, 97%, and 100% respectively at the end of the study period). In total, 12,298 prescriptions were written from 2008–20016. Eighty percent (9,875) were NTF and 17% (2,016) were FQ’s. The remaining 1% and 2% were TMP/SMX and ‘Other’, respectively. Conclusion After changes in prescribing practice in 2001, NTF was used in 80% of cystitis cases over 15 years and retained excellent activity against common urinary pathogens. FQ’s retained acceptable activity for empiric use for urinary tract infections, but susceptibilities trended down notably despite limited FQ use. TMP/SMX did not regain increased activity over the time period. Disclosures All authors: No reported disclosures.

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Changes in the management of urinary tract infections in women: impact of the new recommendations on antibiotic prescribing behavior in France, between 2014 and 2019

BMC Health Services Research ◽

10.1186/s12913-021-06653-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Arthur Piraux ◽

Sébastien Faure ◽

Kurt G. Naber ◽

Jakhongir F. Alidjanov ◽

Aline Ramond-Roquin

Keyword(s):

Urinary Tract ◽

Urinary Tract Infections ◽

Secondary Care ◽

Administrative Database ◽

Community Pharmacies ◽

Antibiotic Prescribing ◽

Prescribing Behavior ◽

Using Data ◽

New Guidelines ◽

Tract Infections

Abstract Background Urinary tract infections (UTIs) are among the most common infections that require antibiotic therapy. In December 2015, new guidelines for UTI management were published in France with the aim of reducing antibiotic misuse and the risk of antimicrobial resistance. Objectives To analyze changes in antibiotic prescribing behavior for acute uncomplicated UTI in women in France from 2014 to 2019. Methods Retrospective study using data extracted from the medico-administrative database ‘OpenMedic’ that is linked to the French National Health Data System and collects data on the reimbursement of prescribed drugs. The analyses focused on the number of boxes of antibiotics delivered by community pharmacies, the molecule class, and the prescriber’s specialty. Results Overall, antibiotic dispensing by community pharmacies increased by 2% between 2014 and 2019, but with differences in function of the antibiotic class. The use of antibiotics recommended as first-line and second-line treatment increased (+ 41% for fosfomycin and + 7430% for pivmecillinam). Conversely, the dispensing of lomefloxacin and norfloxacin decreased by 80%, and that of ciprofloxacin by 26%. Some antibiotics were mostly prescribed by general practitioners (lomefloxacin, pivmecillinam) and others by secondary care physicians (ofloxacin). Dispensing increased for antibiotics prescribed by secondary care physicians (+ 13% between 2014 and 2019) and decreased for antibiotics prescribed by GPs (− 2% for the same period). Conclusion These data suggest that the new recommendations are followed, as indicated by the increased prescription of fosfomycin and pivmecillinam and decreased prescription of fluoroquinolones. However, the efficient transmission and implementation of new recommendations by practitioners requires time, means and dedicated tools.

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Measuring Antibiotic Appropriateness for Urinary Tract Infections in Nursing Home Residents

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2017.96 ◽

2017 ◽

Vol 38 (8) ◽

pp. 998-1001 ◽

Cited By ~ 10

Author(s):

Taniece Eure ◽

Lisa L. LaPlace ◽

Richard Melchreit ◽

Meghan Maloney ◽

Ruth Lynfield ◽

...

Keyword(s):

Urinary Tract Infection ◽

Nursing Home ◽

Urinary Tract ◽

Tract Infection ◽

Urinary Tract Infections ◽

Nursing Home Residents ◽

Infect Control Hosp ◽

Antibiotic Prescribing ◽

Appropriate Use ◽

Tract Infections

We assessed the appropriateness of initiating antibiotics in 49 nursing home (NH) residents receiving antibiotics for urinary tract infection (UTI) using 3 published algorithms. Overall, 16 residents (32%) received prophylaxis, and among the 33 receiving treatment, the percentage of appropriate use ranged from 15% to 45%. Opportunities exist for improving UTI antibiotic prescribing in NH.Infect Control Hosp Epidemiol 2017;38:998–1001

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1686. Microbiology of Community-Onset Urinary Tract Infections in the United States, 2012-2017

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1864 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S826-S827

Author(s):

Leigh Ellyn Preston ◽

Clifford McDonald ◽

Babatunde Olubajo ◽

Natalie McCarthy ◽

Sujan Reddy ◽

...

Keyword(s):

United States ◽

Antibiotic Resistance ◽

Urinary Tract ◽

Urinary Tract Infections ◽

Relative Frequency ◽

The United States ◽

Antibiotic Prescribing ◽

Factors Associated ◽

Tract Infections ◽

Community Onset

Abstract Background Community-onset urinary tract infections (coUTIs) are one of the most common indications for antibiotic prescribing. It is important to understand patient demographic factors associated with microorganisms causing coUTI and their antibiotic resistance profiles, to tailor antibiotic prescribing practices. We analyzed microbiology data to understand factors associated with coUTI in the United States (US). Methods CoUTIs were identified in the Premier Healthcare Database and Cerner Health Facts among patients treated at participating healthcare facilities in the US between 2012-2017. Cases were defined by urine cultures yielding a bacterial organism and were collected in outpatient settings or within three days of hospitalization. Only the first specimen for each encounter was included in the analysis. Data on the organisms isolated, patient’s age, sex, and US census regions of the submitting facilities were described and compared using chi-square tests for associations. Encounters were classified as inpatient (INPT), observation (OBS), emergency department (ED), and outpatient (OTPT) based on the setting in which the culture was submitted. Results Using data from 637 acute care hospitals, urine samples from 3,291,561 encounters were included, with 776,653 (25.7%) INPT, 1,063,219 (34.8%) ED, 107,760 (3.5%) OBS, and 1,092,658 (35.8%) OTPT. The pathogens most frequently associated with coUTIs were Escherichia coli (57.3%), Klebsiella pneumoniae (9.7%), Enterococcus faecalis (5.1%), Proteus mirabilis (4.9%), and Pseudomonas aeruginosa (2.9%). Female sex, age < 65y and OTPT and ED settings were associated with higher relative frequency of E. coli (all p < 0.0001). Male sex, INPT setting and age >65 y were associated with higher relative frequency of P. aeruginosa, P. mirabilis and E. faecalis (all p < 0.0001, Figure). K. pneumoniae was found at higher relative frequency in those >45y, and in INPT and OBS settings (all p < 0.0001). Figure. Distribution of pathogens most frequently associated with community onset urinary tract infections Conclusion Understanding patient factors associated with the microbiology of coUTIs is an important step in developing treatment recommendations and antibiotic stewardship efforts. Further analyses will include assessing the impact of major antibiotic resistance phenotypes, geographic and healthcare settings. Disclosures All Authors: No reported disclosures

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An Assessment of Inappropriate Antibiotic Use and Guideline Adherence for Uncomplicated Urinary Tract Infections

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy198 ◽

2018 ◽

Vol 5 (9) ◽

Cited By ~ 27

Author(s):

Michael J Durkin ◽

Matthew Keller ◽

Anne M Butler ◽

Jennie H Kwon ◽

Erik R Dubberke ◽

...

Keyword(s):

Urinary Tract ◽

Urinary Tract Infections ◽

Antibiotic Use ◽

Emergency Department Visits ◽

Antibiotic Prescribing ◽

Prescribing Practices ◽

Duration Of Treatment ◽

Minimal Impact ◽

Tract Infections ◽

The Impact

Abstract Background In 2011, The Infectious Diseases Society of America released a clinical practice guideline (CPG) that recommended short-course antibiotic therapy and avoidance of fluoroquinolones for uncomplicated urinary tract infections (UTIs). Recommendations from this CPG were rapidly disseminated to clinicians via review articles, UpToDate, and the Centers for Disease Control and Prevention website; however, it is unclear if this CPG had an impact on national antibiotic prescribing practices. Methods We performed a retrospective cohort study of outpatient and emergency department visits within a commercial insurance database between January 1, 2009, and December 31, 2013. We included nonpregnant women aged 18–44 years who had an International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code for a UTI with a concurrent antibiotic prescription. We performed interrupted time series analyses to determine the impact of the CPG on the appropriateness of the antibiotic agent and duration. Results We identified 654 432 women diagnosed with UTI. The patient population was young (mean age, 31 years) and had few comorbidities. Fluoroquinolones, nonfirstline agents, were the most commonly prescribed antibiotic class both before and after release of the guidelines (45% vs 42%). Wide variation was observed in the duration of treatment, with >75% of prescriptions written for nonrecommended treatment durations. The CPG had minimal impact on antibiotic prescribing behavior by providers. Conclusions Inappropriate antibiotic prescribing is common for the treatment of UTIs. The CPG was not associated with a clinically meaningful change in national antibiotic prescribing practices for UTIs. Further interventions are necessary to improve outpatient antibiotic prescribing for UTIs.

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Validating Use of Electronic Health Data to Identify Patients with Urinary Tract Infections in Outpatient Settings

Antibiotics ◽

10.3390/antibiotics9090536 ◽

2020 ◽

Vol 9 (9) ◽

pp. 536

Author(s):

George Germanos ◽

Patrick Light ◽

Roger Zoorob ◽

Jason Salemi ◽

Fareed Khan ◽

...

Keyword(s):

Urinary Tract ◽

Urinary Tract Infections ◽

Chart Review ◽

International Classification Of Diseases ◽

Primary Care Settings ◽

Diagnosis Codes ◽

Classification Of Diseases ◽

Icd 10 ◽

Tract Infections ◽

Outpatient Settings

Objective: To validate the use of electronic algorithms based on International Classification of Diseases (ICD)-10 codes to identify outpatient visits for urinary tract infections (UTI), one of the most common reasons for antibiotic prescriptions. Methods: ICD-10 symptom codes (e.g., dysuria) alone or in addition to UTI diagnosis codes plus prescription of a UTI-relevant antibiotic were used to identify outpatient UTI visits. Chart review (gold standard) was performed by two reviewers to confirm diagnosis of UTI. The positive predictive value (PPV) that the visit was for UTI (based on chart review) was calculated for three different ICD-10 code algorithms using (1) symptoms only, (2) diagnosis only, or (3) both. Results: Of the 1087 visits analyzed, symptom codes only had the lowest PPV for UTI (PPV = 55.4%; 95%CI: 49.3–61.5%). Diagnosis codes alone resulted in a PPV of 85% (PPV = 84.9%; 95%CI: 81.1–88.2%). The highest PPV was obtained by using both symptom and diagnosis codes together to identify visits with UTI (PPV = 96.3%; 95%CI: 94.5–97.9%). Conclusions: ICD-10 diagnosis codes with or without symptom codes reliably identify UTI visits; symptom codes alone are not reliable. ICD-10 based algorithms are a valid method to study UTIs in primary care settings.

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Antibiotic Prescribing Patterns in Italian Hospital Inpatients with Pneumonia, Chronic Obstructive Pulmonary Disease, and Urinary Tract Infections

Annals of Pharmacotherapy ◽

10.1177/106002809302700103 ◽

1993 ◽

Vol 27 (1) ◽

pp. 18-22 ◽

Cited By ~ 7

Author(s):

Luigi Guglielmo ◽

Roberto Leone ◽

Ugo Moretti ◽

Anita Conforti ◽

Alvise Spolaor ◽

...

Keyword(s):

Risk Factors ◽

Chronic Obstructive Pulmonary Disease ◽

Urinary Tract ◽

Urinary Tract Infections ◽

Prescribing Patterns ◽

Chronic Obstructive ◽

Antibiotic Prescribing ◽

Obstructive Pulmonary Disease ◽

Tract Infections ◽

Hospital Inpatients

OBJECTIVE: The primary objective of this study was to describe the antibiotic prescribing patterns in hospital inpatients with pneumonia (PN), exacerbations of chronic obstructive pulmonary disease (COPD), and urinary tract infections (UTIs). A second objective was to verify if some selected variables (i.e., risk factors, patient age, size of hospitals) were affecting the therapeutic choice. DESIGN: Survey was performed on 1609 patients. The data were collected by physicians using a special form, covering a six-month period. SETTING: Twenty-six medical wards and 8 geriatric wards in 24 acute-care hospitals in the Veneto Region in Northern Italy. PATIENTS: A consecutive sample of PN, COPD, and UTI patients treated with antibiotics. MAIN OUTCOME MEASURES: The following information was collected: patient and hospital demographics, risk factors, diagnoses, and antibiotic regimens. RESULTS: Sixty-three antimicrobial agents used, with 2115 administrations, 1227 of which were single-drug therapy. The most frequently used drugs were third-generation cephalosporins (24.6 percent), fluoroquinolones (15.4 percent), aminopenicillins (15.0 percent), and ureidopenicillins (9.7 percent). There is great variability of therapeutic regimens in the various hospitals for the same disease. However, this variability is not explained by the different types of hospitals or by the patients' characteristics (e.g., age, risk factors). CONCLUSIONS: Our results show that the use of broad-spectrum antibiotics probably is excessive. Moreover, the treatment seems to be based more on the opinion of the treating physician and the local habits rather than objective criteria. These factors may have negative repercussions not only in economic terms, but also in terms of alteration of the bacterial ecology.

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1118. Trends of Paediatric Prescribing for Common Infections in British Columbia

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.982 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S397-S397

Author(s):

Ariana Saatchi ◽

David M Patrick ◽

James McCormack ◽

Andrew Morris ◽

Fawziah Marra

Keyword(s):

Urinary Tract ◽

Respiratory Tract ◽

Urinary Tract Infections ◽

Respiratory Tract Infections ◽

Antibiotic Use ◽

Pediatric Care ◽

Antibiotic Prescribing ◽

Upper Respiratory Tract ◽

Upper Respiratory ◽

Tract Infections

Abstract Background Antibiotic prescribing in pediatric care is highly prevalent, and quite often children are prescribed for conditions which are commonly self-limiting and viral in etiology. The purpose of this study was to examine the scope of pediatric antibiotic prescribing by indication, from 2013 to 2016, and identify potential new targets for provincial antimicrobial stewardship efforts. Methods Antibiotic prescription data for children were extracted from a provincial prescription database, and linked to physician billing data in order to obtain diagnostic information. Prescription rates were then calculated, and trends were examined by indication. Major categories included: upper respiratory tract infection, acute otitis media, lower respiratory tract, skin and soft tissue, and urinary tract infections. Results Our database included an average of 244,763 children per year, and 5,896,173 total antibiotic prescriptions. Increased indication-specific rates of prescribing were observed in children aged 0–2 years, for every category. Children aged 3–18 years experienced decreased prescribing across all indications, with the exception of urinary tract infections for those aged between 10–18 years. Urinary tract infections increased by 134% for children aged 0–2 years, and 75% for those aged 10–18 years, from 2013 to 2016. Although antibiotic use for upper respiratory tract infections decreased by 11% for all ages, these diagnoses continue to be prescribed for at rates 2 – 5 times higher than other conditions. Conclusion Although this study found a decrease in prescribing over time across all indications, antibiotic use continues to be a concern for upper respiratory tract infections in pediatric care. These diagnoses generally do not require antibiotics, and inappropriate prescribing is a major factor in antimicrobial resistance. The increased prescribing rates in the youngest age group (0–2 years) offers a new target for provincial stewardship efforts. Disclosures All authors: No reported disclosures.

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Assessment of Appropriate Antibiotic Prescribing for Urinary Tract Infections in an Internal Medicine Clinic

Southern Medical Journal ◽

10.14423/smj.0000000000000278 ◽

2015 ◽

Vol 108 (5) ◽

pp. 300-304 ◽

Cited By ~ 4

Author(s):

Meredith Sigler ◽

Julie Ehret Leal ◽

Katherine Bliven ◽

Brittany Cogdill ◽

Amy Thompson

Keyword(s):

Internal Medicine ◽

Urinary Tract ◽

Urinary Tract Infections ◽

Antibiotic Prescribing ◽

Medicine Clinic ◽

Internal Medicine Clinic ◽

Tract Infections

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Impact of Education and Data Feedback on Guideline Concordant Prescribing for Urinary Tract Infections in the Outpatient Setting

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab214 ◽

2021 ◽

Author(s):

Jason R Funaro ◽

Rebekah W Moehring ◽

Beiyu Liu ◽

Hui-Jie Lee ◽

Siyun Yang ◽

...

Keyword(s):

Urinary Tract ◽

Urinary Tract Infections ◽

Phase 1 ◽

Routine Data ◽

Prescribing Patterns ◽

Urgent Care ◽

Antibiotic Prescribing ◽

Phase 2 ◽

Data Feedback ◽

Tract Infections

Abstract Background Urinary tract infections (UTIs) are the most common outpatient indication for antibiotics and an important target for antimicrobial stewardship (AS) activities. With The Joint Commission standards now requiring outpatient AS, data supporting effective strategies are needed. Methods We conducted a two-phase, prospective, quasi-experimental study to estimate the effect of an outpatient AS intervention on guideline-concordant antibiotic prescribing in a primary care (PC) and urgent care (UC) clinic between August 2017 and July 2019. Phase 1 of the intervention included the development of clinic-specific antibiograms and UTI diagnosis and treatment guidelines, presented during educational sessions with clinic providers. Phase 2, consisting of routine clinic- and provider-specific feedback, began approximately twelve months after the initial education. The primary outcome was percent of encounters with first- or second-line antibiotics prescribed according to clinic-specific guidelines, and was assessed using an interrupted time series approach. Results Data were collected on 4,724 distinct patients seen during 6,318 UTI encounters. The percent of guideline-concordant prescribing increased by 22% (95% CI: 12% to 32%) after Phase 1 education, but decreased by 0.5% every two weeks afterwards (95% CI: -0.9% to 0%). Following routine data feedback in Phase 2, guideline concordance stabilized and significant further decline was not seen (-0.6%, 95% CI: -1.6% to 0.4%). This shift in prescribing patterns resulted in a 52% decrease in fluoroquinolone use. Conclusions Clinicians increased guideline-concordant prescribing, reduced UTI diagnoses, and limited use of high-collateral damage agents following this outpatient AS intervention. Routine data feedback was effective to maintain the response to the initial education.

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