Urinary tract infections in Australian aged care homes: Antibiotic prescribing practices and concordance to national guidelines

2020 ◽  
Vol 48 (3) ◽  
pp. 261-266 ◽  
Author(s):  
Leslie Dowson ◽  
Noleen Bennett ◽  
Kirsty Buising ◽  
Caroline Marshall ◽  
N. Deborah Friedman ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Aged Care ◽  
Care Homes ◽  
Antibiotic Prescribing ◽  
Prescribing Practices ◽  
National Guidelines ◽  
Tract Infections

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

2018 ◽  
Vol 5 (9) ◽  
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.

scholarly journals 1082. Hold the Phone: Antibiotic Prescribing Practices Associated with Nonvisit Encounters for Urinary Tract Infections (UTIs) in Urology Clinics

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S384-S384
Author(s):  
Nina Akbar ◽  
Erica L Dobson ◽  
Michael Keefer ◽  
Sonal Munsiff ◽  
Ghinwa Dumyati
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Treatment Guidelines ◽  
Antibiotic Use ◽  
Multidrug Resistant ◽  
Outpatient Setting ◽  
Antibiotic Prescribing ◽  
Prescribing Practices ◽  
Medical Provider ◽  
Tract Infections

Abstract Background Surveillance data uncovers a high proportion of multidrug-resistant Gram-negative organisms found in the outpatient setting, often in patients with recurrent urinary tract infections (UTIs), underlying urologic abnormalities, and prior treatment for UTIs. We assessed prescribing practices at urology clinics to identify potential stewardship strategies for UTI management. Methods Antibiotic prescription encounters for adult patients from nine urology clinics were obtained from July to September 2018 using the EHR. We collected encounter types (visit or nonvisit), ordering medical provider types, antibiotic classes and patient demographics. A subset of 50 randomized, unique patient telephone encounters (TEs) was reviewed for documentation of a UTI diagnosis, symptoms, urinalysis and culture results, antibiotic prescriptions and duration. Results A total of 1,704 antibiotic orders were identified for 1,210 patients (48% female, median age 69 years, IQR 20). The majority (75%) of antibiotic encounters were from nonvisits: TEs (39%), orders only (25%), refills (9%), and patient email (2%). Major prescribers were advanced practice providers (APPs, 61%) followed by attending physicians (38%). Antibiotics prescribed were fluoroquinolones (FQs, 27%), nitrofurantoin (24%), first-generation cephalosporins (16%), and trimethoprim–sulfamethoxazole (15%). From the subset of 50 TEs, APPs wrote 76% of prescriptions and 32% of all orders were FQs. Thirty-nine patients had a clinical UTI diagnosis, yet 33% (13/39) did not have documentation of at least one urinary sign or symptom. For symptomatic patients, 15% (4/26) did not have a urine culture result within one week before or after the TE date. The distribution of antibiotics prescribed was similar to overall use and the median duration was 7 days. Conclusion Urology practices care for patients with the most complicated urinary tract pathology and appropriate antibiotic use in this population is a challenge. We found that urology providers often prescribe antibiotics to elderly patients without in-person visits, documentation of symptoms or microbiologic evidence of a UTI. Stewardship efforts should involve APPs, developing diagnostic and treatment guidelines for UTIs and improving documentation for antibiotic orders. Disclosures All authors: No reported disclosures.

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

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.

scholarly journals Adherence to International Guidelines for the Treatment of Uncomplicated Urinary Tract Infections in Lebanon

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Wissam K. Kabbara ◽  
Mohamad M. Meski ◽  
Wijdan H. Ramadan ◽  
Dina S. Maaliki ◽  
Pascale Salameh
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Bacterial Resistance ◽  
Bivariate Analysis ◽  
Antibiotic Prescribing ◽  
Prescribing Practices ◽  
Chi Square ◽  
Duration Of Therapy ◽  
Chi Square Test ◽  
Tract Infections

Objective. The purpose of this study is to evaluate antibiotic-prescribing practices and adherence to IDSA guidelines for the treatment of uncomplicated urinary tract infections in Lebanon. Methods. This observational prospective study was conducted in 15 community pharmacies in Lebanon over 1 year in adult females. A regimen of nitrofurantoin 100 mg bid for 5 days or fosfomycin 3 grams single dose were considered appropriate. For the bivariate analysis, the chi-square test was used. Results. A total of 376 patients were included in this study. The prescribed antibiotic was appropriate in 35 percent of the patients. Age (more than 50 years) did not significantly affect the appropriateness of the prescribed antibiotic (p=0.508). The frequency of attacks per year (more than 3) negatively affected the choice of antibiotic (p=0.025). The dose and duration of the prescribed antibiotic was appropriate in 73 and 58 percent of the patients, respectively, with a significant inappropriate dose and duration with fluoroquinolones as compared to nitrofurantoin and fosfomycin (p<0.001 for the dose and p=0.014 for the duration of therapy). Conclusions. In an era of increasing bacterial resistance, interventions that improve physicians’ prescribing practices for uncomplicated urinary tract infections are needed.

scholarly journals Comparison of diagnosis and prescribing practices between virtual visits and office visits for adults diagnosed with uncomplicated urinary tract infections within a primary care network

2020 ◽  
pp. 1-6
Author(s):  
Kaitlyn L. Johnson ◽  
Lisa E. Dumkow ◽  
Lisa A. Salvati ◽  
Kristen M. Johnson ◽  
Megan A. Yee ◽  
...  
Keyword(s):  
Primary Care ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Antibiotic Prescribing ◽  
Office Visits ◽  
Prescribing Practices ◽  
Care Network ◽  
Antimicrobial Prescribing ◽  
Virtual Visits ◽  
Tract Infections

Abstract Objectives: Telemedicine visits are an increasingly popular method of care for mild infectious complaints, including uncomplicated urinary tract infections (UTIs), and they are an important target for antimicrobial stewardship programs (ASPs) to evaluate quality of prescribing. In this study, we compared antimicrobial prescribing in a primary care network for uncomplicated UTIs treated through virtual visits and at in-office visits. Design: Retrospective cohort study comparing guideline-concordant antibiotic prescribing for uncomplicated UTI between virtual visits and office visits. Setting: Primary care network composed of 44 outpatient sites and a single virtual visit platform. Patients: Adult female patients diagnosed with a UTI between January 1 and December 31, 2018. Methods: Virtual visit prescribing was compared to office visit prescribing, including agent, duration, and patient outcomes. The health system ASP provides annual education to all outpatient providers regarding local antibiogram trends and prescribing guidelines. Guideline-concordant therapy was assessed based on the network’s ASP guidelines. Results: In total, 350 patients were included, with 175 per group. Patients treated for a UTI through a virtual visit were more likely to receive a first-line antibiotic agent (74.9% vs 59.4%; P = .002) and guideline-concordant duration (100% vs 53.1%; P < .001). Patients treated through virtual visits were also less likely to have a urinalysis (0% vs 97.1%; P < .001) or urine culture (0% vs 73.1%; P < .001) ordered and were less likely to revisit within 7 days (5.1% vs 18.9%; P < .001). Conclusions: UTI care through a virtual visit was associated with more appropriate antimicrobial prescribing compared to office visits and decreased utilization of diagnostic and follow-up resources.

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

2020 ◽  
Vol 41 (S1) ◽  
pp. s453-s454
Author(s):  
Hasti Mazdeyasna ◽  
Shaina Bernard ◽  
Le Kang ◽  
Emily Godbout ◽  
Kimberly Lee ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Private Insurance ◽  
Geographic Region ◽  
Study Cohort ◽  
Antibiotic Prescribing ◽  
Prescribing Trends ◽  
Icd 10 ◽  
Tract Infections ◽  
Insurance Payer

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.

scholarly journals 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

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.

scholarly journals Measuring Antibiotic Appropriateness for Urinary Tract Infections in Nursing Home Residents

2017 ◽  
Vol 38 (8) ◽  
pp. 998-1001 ◽  
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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