| Abstrakt: |
PURPOSE In the United States, complaints of urinary tract infection (UTI) symptoms account for about 7 million office visits and 1 million ED visits annually, making uncomplicated UTIs one of the leading causes for antibiotic prescribing in primary care. The Infectious Diseases Society of America (IDSA) guidelines recommend nitrofurantoin 100 mg twice daily for 5 days as first-line treatment. This retrospective chart review looked at patients presenting to the University of Utah Hospital ED who were diagnosed with an uncomplicated UTI, and sought to determine what percentage of patients were appropriately prescribed first-line antibiotics according to IDSA guidelines. METHODS A retrospective chart review was conducted of patients seen in the ED between September 1, 2021, and February 28, 2022, who were diagnosed with uncomplicated UTIs and treated. An uncomplicated UTI was defined as an infection of the lower urinary tract in healthy, nonpregnant, adult premenopausal women with the presence of urinary symptoms (such as pain with urination and urgency) and bacteriuria. Patients included in the study did not have fever, flank pain, or pyelonephritis. The study inclusion criteria were: cisgender women of childbearing age (ages 18 to 65 years) with a primary complaint of dysuria, urinary hesitancy, frequency, urgency, or suprapubic pain. Patients were excluded if they were pregnant or had an allergy to nitrofurantoin, history of UTI with resistant pathogen, UTI diagnosis in past month, antibiotic therapy in past 2 weeks, current sexually transmitted infection, immunocompromise, or any symptoms indicative of pyelonephritis. The main outcome measure was antibiotics prescribed consistent with IDSA guidelines. Data were analyzed with descriptive statistics using SPSS v. 27. RESULTS Of the 150 patients initially identified, 79 were retained for the final analysis. The mean age was 30.9 ± 13.3 years; mean height, 163.2 ± 20.2 cm; mean weight, 69.3 ± 17.4 kg; and mean BMI, 25.3 ± 6.06 kg/m². Nearly 85% of the patients identified as White, 7.6% as Asian, 91.1% as non-Hispanic, and 2.5% as Hispanic or Latinx. More than 87% of patients had private insurance, 10% had Medicaid, and about 80% lived in Salt Lake County. Nearly 17% of patients received treatment consistent with IDSA guidelines: 64.6% received nitrofurantoin, 23.5% received 5 days of treatment, 76.5% received 7 days of treatment, and 98.7% received a point-of-care urinalysis. Nearly 71% of patients received a urine culture, which revealed Escherichia coli in 36.7%, mixed flora in 11.4%, and no growth in 7.6%. CONCLUSIONS The data support the community partner's perception of nonadherence to IDSA guidelines. Clinicians may not be aware of the IDSA guidelines for uncomplicated UTI treatment. Nitrofurantoin was more frequently prescribed, but the duration was incorrect. Most patients received urine cultures, which is not recommended by IDSA. The study limitations include manual data acquisition and that clinician notes or primary diagnosis codes lacked details on the medical decision-making for screening. [ABSTRACT FROM AUTHOR] |
