1518. Assessment of Antibiotic Prescribing in the Outpatient Setting for Uncomplicated Urinary Tract Infection in Pediatrics (UTIP Trial) with a Review of Local E. coli Susceptibilities

BackgroundRegional variations in the presentation of uncomplicated urinary tract infection (UTI) and pathogen sensitivity to antibiotics have been cited as reasons to justify differences in how the infections are managed, which includes the prescription of broad-spectrum antibiotics.AimTo describe presentation and management of UTI in primary care settings, and explore the association with patient recovery, taking microbiological findings and case mix into account.Design and settingProspective observational study of females with symptoms of uncomplicated UTI presenting to primary care networks in England, Wales, the Netherlands, and Spain.MethodClinicians recorded history, symptom severity, management, and requested mid-stream urine culture. Participants recorded, in a diary, symptom severity each day for 14 days. Time to recovery was compared between patient characteristics and between countries using two-level Cox proportional hazards models, with patients nested within practices.ResultsIn total, 797 females attending primary care networks in England (n = 246, 30.9% of cohort), Wales (n = 213, 26.7%), the Netherlands (n = 133, 16.7%), and Spain (n = 205, 25.7%) were included. In total, 259 (35.8%, 95% confidence interval 32.3 to 39.2) of 726 females for whom there was a result were urine culture positive for UTI. Pathogens and antibiotic sensitivities were similar. Empirical antibiotics were prescribed for 95.1% in England, 92.9% in Wales, 95.1% in Spain, and 59.4% in the Netherlands There were no meaningful differences at a country network level before and after controlling for severity, prior UTIs, and antibiotic prescribing.ConclusionVariation in presentation and management of uncomplicated UTI at a country primary care network level is clinically unwarranted and highlights a lack of consensus concerning optimal symptom control and antibiotic prescribing.

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Rural–urban differences in antibiotic prescribing for uncomplicated urinary tract infection

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2021.21 ◽

2021 ◽

pp. 1-8

Author(s):

Abbye W. Clark ◽

Michael J. Durkin ◽

Margaret A. Olsen ◽

Matthew Keller ◽

Yinjiao Ma ◽

...

Keyword(s):

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Rural Women ◽

Antibiotic Use ◽

Antibiotic Prescribing ◽

Oral Antibiotic ◽

Uncomplicated Urinary Tract Infection ◽

Urban Status ◽

To Receive

Abstract Objective: To examine rural–urban differences in temporal trends and risk of inappropriate antibiotic use by agent and duration among women with uncomplicated urinary tract infection (UTI). Design: Observational cohort study. Methods: Using the IBM MarketScan Commercial Database (2010–2015), we identified US commercially insured women aged 18–44 years coded for uncomplicated UTI and prescribed an oral antibiotic agent. We classified antibiotic agents and durations as appropriate versus inappropriate based on clinical guidelines. Rural–urban status was defined by residence in a metropolitan statistical area. We used modified Poisson regression to determine the association between rural–urban status and inappropriate antibiotic receipt, accounting for patient- and provider-level characteristics. We used multivariable logistic regression to estimate trends in antibiotic use by rural–urban status. Results: Of 670,450 women with uncomplicated UTI, a large proportion received antibiotic prescriptions for inappropriate agents (46.7%) or durations (76.1%). Compared to urban women, rural women were more likely to receive prescriptions with inappropriately long durations (adjusted risk ratio 1.10, 95% CI, 1.10–1.10), which was consistent across subgroups. From 2011 to 2015, there was slight decline in the quarterly proportion of patients who received inappropriate agents (48.5% to 43.7%) and durations (78.3% to 73.4%). Rural–urban differences varied over time by agent (duration outcome only), geographic region, and provider specialty. Conclusions: Inappropriate antibiotic prescribing is quite common for the treatment of uncomplicated UTI. Rural women are more likely to receive inappropriately long antibiotic durations. Antimicrobial stewardship interventions are needed to improve outpatient UTI antibiotic prescribing and to reduce unnecessary exposure to antibiotics, particularly in rural settings.

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Uncomplicated Urinary Tract Infection in Ambulatory Primary Care Pediatrics: Are We Using Antibiotics Appropriately?

The Journal of Pediatric Pharmacology and Therapeutics ◽

10.5863/1551-6776-24.1.39 ◽

2019 ◽

Vol 24 (1) ◽

pp. 39-44 ◽

Cited By ~ 4

Author(s):

Ban AL-Sayyed ◽

Jeremy Le ◽

Mohammad Mousbah Al-Tabbaa ◽

Brian Barnacle ◽

Jinma Ren ◽

...

Keyword(s):

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Antibiotic Treatment ◽

Antimicrobial Stewardship ◽

White Blood Cells ◽

Outpatient Setting ◽

Diagnosis And Treatment ◽

Uncomplicated Urinary Tract Infection ◽

The Cost

OBJECTIVES Antimicrobial stewardship programs target antimicrobial use within the inpatient care setting. However, most antimicrobials are prescribed at ambulatory sites. We aim to determine the appropriateness of the diagnosis and treatment of uncomplicated urinary tract infection (UTI) in children within the outpatient setting at our institution, and to evaluate the cost of antibiotic treatment in our patient cohort. METHODS This retrospective study was conducted by reviewing electronic records of patients aged 2 to 18 years diagnosed with uncomplicated UTI and treated with antibiotics in the outpatient setting from January 1, 2016, to April 30, 2016. Appropriate diagnosis was defined as confirmed UTI that included: pyuria (>5 white blood cells per high-power field or positive for leukocyte esterase), a positive urine culture (≥50,000 colony units/mL of a single uropathogen for a catheterized sample or ≥100,000 colony units/mL for a clean catch urine sample), and lower urinary tract symptoms. Treatment was considered appropriate if the patient was prescribed first-line antibiotic for the susceptible isolate (trimethoprim sulfamethoxazole, amoxicillinclavulanate, nitrofurantoin, and cephalexin), and if the appropriate dose was used. RESULTS We included 178 patients receiving a diagnosis of uncomplicated UTI and treated with antibiotics. Of these, 70% received an inappropriate diagnosis (n = 125). 58% (n= 72) of improperly diagnosed patients had polymicrobial growth in their urine cultures. Antibiotics prescribed mostly in this group were trimethoprim-sulfamethoxazole (53%, n = 66) and cephalexin (22%, n = 27). Only 30% of all included patients received an appropriate diagnosis (n = 53). Of all appropriate diagnosis patients (n = 53), 26% were treated inappropriately (n = 14) with either wide-spectrum antibiotics (n = 8) or with low calculated dose (n = 6). The estimated cost of antibiotic treatment for the inappropriate diagnosis group (n = 125) was $10,755.87. CONCLUSION Antimicrobial stewardship programs should target the pediatric outpatient setting and antibiograms should be developed. Education of providers about the appropriate diagnosis and treatment of uncomplicated UTI in children is essential for reducing the cost of inappropriate therapy.

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Outpatient Antibiotic Prescribing Practices for Uncomplicated Urinary Tract Infection in Women in the United States, 2002–2011

Open Forum Infectious Diseases ◽

10.1093/ofid/ofw159 ◽

2016 ◽

Vol 3 (3) ◽

Cited By ~ 34

Author(s):

Miwako Kobayashi ◽

Daniel J. Shapiro ◽

Adam L. Hersh ◽

Guillermo V. Sanchez ◽

Lauri A. Hicks

Keyword(s):

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Medical Care ◽

Antibiotic Prescription ◽

Antibiotic Prescribing ◽

Uncomplicated Urinary Tract Infection ◽

Prescribing Practices ◽

Outpatient Visits ◽

Ambulatory Medical Care

Abstract Background. Urinary tract infection (UTI) is one of the most common diagnoses leading to an antibiotic prescription for women seeking ambulatory care. Understanding current national outpatient antibiotic prescribing practices will help ongoing stewardship efforts to optimize antibiotic use; however, information on recent national outpatient antibiotic prescribing trends for UTI is limited. Methods. We analyzed the National Ambulatory Medical Care and National Hospital Ambulatory Medical Care Survey datasets from 2002 to 2011. Outpatient visits of women aged ≥18 years with a diagnosis of uncomplicated UTI were included for analysis. We conducted weighted descriptive analyses, examined time trends in antibiotic prescribing, and used multivariable logistic regression to identify patient and provider factors associated with fluoroquinolone prescribing. Results. A total of 7111 visits were identified. Eighty percent of visits resulted in an antibiotic prescription; fluoroquinolones were the most frequently prescribed antibiotics throughout the study period (49% overall). Older patients (adjusted odds ratio [AOR] for adults aged ≥70 years = 2.5; 95% confidence interval [CI], 1.6–3.8) and patients treated by internists (AOR = 2.0; 95% CI, 1.1–3.3) were more likely than younger patients and those treated by family practitioners to receive fluoroquinolones. Outpatient visits in the West US Census region were less likely to be associated with fluoroquinolone prescribing (AOR = 0.6; 95% CI, .4–1.0) compared with visits in the Northeast. Conclusions. Fluoroquinolones were the most frequently selected antibiotic treatment for uncomplicated UTI in women during the study period. Outpatient antibiotic stewardship initiatives should include efforts to reduce overuse of fluoroquinolones for uncomplicated UTI.

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Single centre observational study on antibiotic prescribing adherence to clinical practice guidelines for treatment of uncomplicated urinary tract infection

Infection Disease & Health ◽

10.1016/j.idh.2018.10.005 ◽

2019 ◽

Vol 24 (2) ◽

pp. 75-81 ◽

Cited By ~ 2

Author(s):

Thienan John Phamnguyen ◽

Grace Murphy ◽

Fahid Hashem

Keyword(s):

Urinary Tract Infection ◽

Clinical Practice ◽

Urinary Tract ◽

Tract Infection ◽

Observational Study ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Antibiotic Prescribing ◽

Uncomplicated Urinary Tract Infection ◽

Single Centre

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Uropathogenic Escherichia coli Outer Membrane Antigens Expressed during Urinary Tract Infection

Infection and Immunity ◽

10.1128/iai.00337-07 ◽

2007 ◽

Vol 75 (8) ◽

pp. 3941-3949 ◽

Cited By ~ 103

Author(s):

Erin C. Hagan ◽

Harry L. T. Mobley

Keyword(s):

Escherichia Coli ◽

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Outer Membrane ◽

Pathogenic Bacteria ◽

Outer Membrane Proteins ◽

Uncomplicated Urinary Tract Infection ◽

E Coli ◽

Membrane Antigens

ABSTRACT Uncomplicated urinary tract infection (UTI) caused by uropathogenic Escherichia coli (UPEC) represents a prevalent and potentially severe infectious disease. In this study, we describe the application of an immunoproteomics approach to vaccine development that has been used successfully to identify vaccine targets in other pathogenic bacteria. Outer membranes were isolated from pyelonephritis strain E. coli CFT073 cultured under conditions that mimic the urinary tract environment, including iron limitation, osmotic stress, human urine, and exposure to uroepithelial cells. To identify antigens that elicit a humoral response during experimental UTI, outer membrane proteins were separated by two-dimensional gel electrophoresis and probed using pooled antisera from 20 CBA/J mice chronically infected with E. coli CFT073. In total, 23 outer membrane antigens, including a novel iron compound receptor, reacted with the antisera and were identified by mass spectrometry. These antigens also included proteins with known roles in UPEC pathogenesis, such as ChuA, IroN, IreA, Iha, IutA, and FliC. These data demonstrate that an antibody response is directed against these virulence-associated factors during UTI. We also show that the genes encoding ChuA, IroN, hypothetical protein c2482, and IutA are significantly more prevalent (P < 0.01) among UPEC strains than among fecal-commensal E. coli isolates. Thus, we suggest that the conserved outer membrane antigens identified in this study could be rational candidates for a UTI vaccine designed to elicit protective immunity against UPEC infection.

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86: Activation of Natural Killer T (NKT) Cells by Alpha-Galactosylceramide Mediates Clearance of E. Coli in Murine Urinary Tract Infection

The Journal of Urology ◽

10.1016/s0022-5347(18)37348-8 ◽

2004 ◽

Vol 171 (4S) ◽

pp. 22-23

Author(s):

Shingo Minagawa ◽

Chikara Ohyama ◽

Shingo Hatakeyama ◽

Kazunari Sato ◽

Shigeru Sato ◽

...

Keyword(s):

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Natural Killer ◽

Nkt Cells ◽

E Coli ◽

Natural Killer T

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Molecular Characterisation of ESBL producer E. coli

International Journal of Medical Sciences ◽

10.32441/ijms.v1i2.75 ◽

2018 ◽

Vol 1 (2) ◽

pp. 40-57

Author(s):

Abdulghani Alsamarai ◽

Shler Khorshed ◽

Imad Weli

Keyword(s):

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Female Student ◽

Clinical Problem ◽

Clinical Isolates ◽

Molecular Characterisation ◽

M Gene ◽

Esbl Producer ◽

E Coli

Background: Antibiotic resistance emerged as clinical problem challenge the effective treatment of infections. Virulence factor may play an important role in the influence of antimicrobial resistance. Objective: To determine the frequency of resistance gene in E. coli clinical isolates from women with urinary tract infection. Materials and Methods: Fifteen E.coli clinical isolates were tested by PCR to determine their molecular characterization. Results: The bla CTX –M gene was not detected in 6.7% out of the tested 15 E. coli clinical isolates from women with urinary tract infection. However, bla OXA gene was detected in all E. coli tested clinical isolates from pregnant women, female student and diabetic women with urinary tract infection. While bla TEM gene and bla SHV gene were not detected in 33.3% and 40% out of the tested E. coli clinical isolates respectively. Conclusions: Four types of ESBL genes were detected, and shows new trend of distribution, which indicated the predominance of OXA and CTX-M genes.

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