Antimicrobial utilization and stewardship in patients with uncomplicated urinary tract infections managed by pharmacists in the community: A sub-study of the RxOUTMAP trial

2021 ◽  
pp. e20200047
Author(s):  
Nathan P Beahm ◽  
Daniel J Smyth ◽  
Ross T Tsuyuki
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Antibacterial Therapy ◽  
Antimicrobial Stewardship ◽  
Red Flags ◽  
Antimicrobial Utilization ◽  
Complicating Factors ◽  
Tract Infections ◽  
Primary Care Professionals ◽  
Antibacterial Prescription

BACKGROUND: Urinary tract infections (UTIs) often lead to suboptimal antibacterial use. Pharmacists are accessible primary care professionals who have an important role to play in antimicrobial stewardship. Our objective was to evaluate the appropriateness of pharmacists’ antibacterial prescribing for patients with uncomplicated UTI. METHODS: We conducted a prospective registry trial with 39 community pharmacies in New Brunswick, Canada. Adult patients were enrolled if they presented to the pharmacy with either symptoms of UTI with no current antibacterial treatment (pharmacist-initial arm) or an antibacterial prescription for UTI from a physician (physician-initial arm). Pharmacists assessed patients; patients with complicating factors or red flags for systemic illness or pyelonephritis were excluded. Pharmacists prescribed antibacterial therapy or modified antibacterial therapy, provided education only, or referred to a physician, as appropriate. Antibacterial therapy prescribed was compared between study arms. RESULTS: Seven hundred fifty patients were enrolled (87% pharmacist-initial arm). The most commonly prescribed agents in the pharmacist-initial arm were nitrofurantoin (88%), sulfamethoxazole–trimethoprim (TMP–SMX) (8%), and fosfomycin (2%); in the physician-initial arm, nitrofurantoin (55%), TMP–SMX (26%), and fluoroquinolones (11%) were prescribed. Therapy was guideline concordant for 95.1% of patients in the pharmacist-initial arm and 35.1% of patients in the physician-initial arm ( p < 0.001). For guideline-discordant therapy from physicians, pharmacists prescribed to optimize therapy for 46% of patients. CONCLUSION: Treatment was highly guideline concordant when pharmacist initiated, with physicians prescribing longer treatment durations and more fluoroquinolones. This represents an important opportunity for antimicrobial stewardship interventions by pharmacists in the community.

scholarly journals Outcomes of Urinary Tract Infection Management by Pharmacists (RxOUTMAP): A study of pharmacist prescribing and care in patients with uncomplicated urinary tract infections in the community

2018 ◽  
Vol 151 (5) ◽  
pp. 305-314 ◽  
Author(s):  
Nathan P. Beahm ◽  
Daniel J. Smyth ◽  
Ross T. Tsuyuki
Keyword(s):  
Patient Satisfaction ◽  
Urinary Tract ◽  
Adverse Events ◽  
Urinary Tract Infections ◽  
Antibacterial Therapy ◽  
Clinical Cure ◽  
Pharmacist Prescribing ◽  
Complicating Factors ◽  
Tract Infections ◽  
Very High

Background: Pharmacists have the authorization to prescribe medications for the treatment of uncomplicated urinary tract infections (UTI) in some provinces. However, there are limited data on the outcomes of this care by pharmacists. Our objective was to evaluate the effectiveness, safety and patient satisfaction with pharmacist prescribing and care in patients with uncomplicated UTI. Methods: We conducted a prospective registry trial in 39 community pharmacies in the Canadian province of New Brunswick. Adult patients were enrolled if they presented to the pharmacy with either symptoms of UTI with no current antibacterial treatment (Pharmacist-Initial Arm) or if they presented with a prescription for an antibacterial to treat UTI from another health care provider (Physician-Initial Arm). Pharmacists assessed patients and if they had complicating factors or red flags for systemic illness or pyelonephritis, they were excluded from the study. Pharmacists either prescribed antibacterial therapy, modified antibacterial therapy, provided education only or referred to physician, as appropriate. The primary outcome was clinical cure at 2 weeks and the secondary outcomes included adverse events and patient satisfaction. Results: A total of 750 patients were enrolled (87.4% in the Pharmacist-Initial Arm), average age was 40.9 (SD 16.0) years. Clinical cure was achieved in 88.9% of patients. Of those that did not have sustained symptom resolution, most (5.5% overall) had symptom recurrence after completion of therapy. Adverse events were reported by 7.2% of patients and 88.9% of those continued their medication. Most adverse events were gastrointestinal-related and transient. The patient satisfaction survey reflected very high levels of satisfaction for the care they received, as well as for trust and accessibility of the pharmacist. Conclusion: Pharmacist management of uncomplicated UTI is effective, safe, and patient satisfaction appears very high.

Outpatient antimicrobial stewardship: Targets for urinary tract infections

2020 ◽  
Vol 48 (9) ◽  
pp. 1009-1012 ◽  
Author(s):  
Bethany A. Wattengel ◽  
Sara DiTursi ◽  
Jennifer L. Schroeck ◽  
John A. Sellick ◽  
Kari A. Mergenhagen
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Antimicrobial Stewardship ◽  
Tract Infections

scholarly journals Urogenital tuberculosis, the cause of ineffective antibacterial therapy for urinary tract infections

2017 ◽  
Vol 10 (3) ◽  
pp. 95-101 ◽  
Author(s):  
Ekaterina Kulchavenya ◽  
Andrey Cherednichenko
Keyword(s):  
Drug Resistance ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Antibacterial Therapy ◽  
Recurrent Utis ◽  
E Coli ◽  
Total Prevalence ◽  
Urogenital Tuberculosis ◽  
History Of ◽  
Tract Infections

Background: Urogenital tuberculosis (UGTB) is one of the great imitators; it is commonly masked by urinary tract infections (UTIs). We aimed to estimate how many UGTB patients were among patients with a long history of UTIs. Material and Methods: A total of 244 patients with recurrent UTIs and suspected UGTB were enrolled in an open, noncomparative prospective study. Their urine and expressed prostate secretion or ejaculate were cultured (a total of 1446 samples), and 421 isolates with growth of ⩾104 colony-forming units (CFU)/ml were investigated for drug resistance. Typically, UGTB diagnosis is made by individual case. Results: All 244 patients had a long history of recurrent UTIs (on average, 7.9 ± 3.4 years); all received at least five courses of antibacterial therapy without good result. UGTB was diagnosed in 63 (25.8%), and in 41 of these (65.1%), there was comorbidity of UTI and UGTB. Of 1446 samples investigated, 421 (29.1%) were positive, and 1025 were negative. Escherichia coli was found in 57.3% of gram-negative microflora and in 29.0% only among all uropathogens. E. coli was resistant to amoxicillin/clavulanate in 51.5–57.1%, to cefotaxime in 50.0–52.0%, to gentamycin in 33.3–59.5%, to ciprofloxacin in 63.2–66.7%, to levofloxacin in 54.8–45.2%, and to nitrofurantoin in 23.5–20.8% in 2015 and 2016, respectively. If, in 2015, all isolates of E. coli were susceptible to imipenem, in 2016, 7.1% of strains were resistant to this antibiotic. Level of drug-resistance was higher in 2016, excluding only levofloxacin and nitrofurantoin. Conclusions: Total prevalence of UGTB among UTI patients with poor results of antibacterial therapy was 25.8%. Comorbidity of UTI and UGTB was diagnosed in 65.1%.

scholarly journals Antibiotic Treatment for Urinary Tract Infections in Nursing Homes: Identifying Opportunities for Antimicrobial Stewardship

2015 ◽  
Vol 2 (suppl_1) ◽  
Author(s):  
Kelly Ground ◽  
Wallace Jones ◽  
Cynthia Drake ◽  
Gregory Gahm ◽  
Sung-Joon Min ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Nursing Homes ◽  
Antibiotic Treatment ◽  
Urinary Tract Infections ◽  
Antimicrobial Stewardship ◽  
Tract Infections
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