Antibiotic Prescribing for Urinary Tract Infections
Antibiotic Prescribing for Urinary Tract Infections
This study was a retrospective chart review of adult patients in an internal medicine clinic diagnosed as having a UTI in a southern US healthcare institution from July 1, 2012 to June 30, 2013. Adults 18 years of age and older with an active UTI were included in the study. Exclusion criteria included pregnant women and patients with charts not having notation of signs and symptoms, vitals, sex, antibiotic prescribed, or length of therapy. Additional exclusion criteria included patients for whom treatment was started outside the internal medicine clinic because these patients received prescriptions from clinics other than that being studied.
All of the data were entered and analyzed in Excel (Microsoft Corporation, Redmond, WA) and SPSS version 22 (IBM SPSS Statistics, Armonk, NY), respectively. Data were analyzed through the use of descriptive statistics, including percentages for categorical variables, and means for continuous variables. Baseline characteristics were analyzed by analysis of variance and Pearson χ for differences between groups. Primary and secondary outcomes were analyzed by Pearson χ to determine whether differences between groups existed. For data evaluation, electronic charts were reviewed, and data were collected for the following: age (in years, or >89 years, if applicable); sex; vital signs; antibiotic allergies; urine cultures and sensitivities; signs and symptoms of infection; laboratory data such as renal function and white blood cell count within 30 days of the antibiotic being prescribed; concomitant disease states such as bladder outlet obstruction, voiding dysfunctions, diabetes mellitus, immunocompromised, postmenopausal, calculi, in-dwelling catheter, and neurogenic bladder; antibiotic prescribed; and dose, frequency, and duration of therapy.
A regimen was considered appropriate if it aligned with IDSA recommendations, based on the classification of UTI, for antibiotic choice, dose, and duration of therapy. Additional factors to determine appropriateness of therapy were patient allergies, contraindications, and renal function. Approval from the institutional review board was obtained in advance of data collection.
The primary goal of the study was to assess the percentage of patients prescribed appropriate therapy (ie, composite of appropriate antibiotic, dose, and duration of therapy) across all UTI categories. Secondary outcomes included the appropriateness of the antibiotic and dose, frequency, and duration of therapy, as individual variables. Patients were considered to have been treated appropriately if their regimen aligned with that suggested by IDSA guidelines for uncomplicated or complicated UTI, pyelonephritis, and catheter-associated UTI, while taking susceptibilities, patient allergies, renal function, and any contraindications to therapy into consideration.
Methods
This study was a retrospective chart review of adult patients in an internal medicine clinic diagnosed as having a UTI in a southern US healthcare institution from July 1, 2012 to June 30, 2013. Adults 18 years of age and older with an active UTI were included in the study. Exclusion criteria included pregnant women and patients with charts not having notation of signs and symptoms, vitals, sex, antibiotic prescribed, or length of therapy. Additional exclusion criteria included patients for whom treatment was started outside the internal medicine clinic because these patients received prescriptions from clinics other than that being studied.
All of the data were entered and analyzed in Excel (Microsoft Corporation, Redmond, WA) and SPSS version 22 (IBM SPSS Statistics, Armonk, NY), respectively. Data were analyzed through the use of descriptive statistics, including percentages for categorical variables, and means for continuous variables. Baseline characteristics were analyzed by analysis of variance and Pearson χ for differences between groups. Primary and secondary outcomes were analyzed by Pearson χ to determine whether differences between groups existed. For data evaluation, electronic charts were reviewed, and data were collected for the following: age (in years, or >89 years, if applicable); sex; vital signs; antibiotic allergies; urine cultures and sensitivities; signs and symptoms of infection; laboratory data such as renal function and white blood cell count within 30 days of the antibiotic being prescribed; concomitant disease states such as bladder outlet obstruction, voiding dysfunctions, diabetes mellitus, immunocompromised, postmenopausal, calculi, in-dwelling catheter, and neurogenic bladder; antibiotic prescribed; and dose, frequency, and duration of therapy.
A regimen was considered appropriate if it aligned with IDSA recommendations, based on the classification of UTI, for antibiotic choice, dose, and duration of therapy. Additional factors to determine appropriateness of therapy were patient allergies, contraindications, and renal function. Approval from the institutional review board was obtained in advance of data collection.
The primary goal of the study was to assess the percentage of patients prescribed appropriate therapy (ie, composite of appropriate antibiotic, dose, and duration of therapy) across all UTI categories. Secondary outcomes included the appropriateness of the antibiotic and dose, frequency, and duration of therapy, as individual variables. Patients were considered to have been treated appropriately if their regimen aligned with that suggested by IDSA guidelines for uncomplicated or complicated UTI, pyelonephritis, and catheter-associated UTI, while taking susceptibilities, patient allergies, renal function, and any contraindications to therapy into consideration.
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