Exploring variations in recommended first-choice therapy for complicated urinary tract infections in males: Insights from outpatient settings across age, race, and ethnicity.
age
antibiotic treatment
disparities
males
outpatient
race/ethnicity
urinary tract infection
Journal
Pharmacotherapy
ISSN: 1875-9114
Titre abrégé: Pharmacotherapy
Pays: United States
ID NLM: 8111305
Informations de publication
Date de publication:
14 Mar 2024
14 Mar 2024
Historique:
revised:
31
01
2024
received:
25
07
2023
accepted:
04
02
2024
medline:
14
3
2024
pubmed:
14
3
2024
entrez:
14
3
2024
Statut:
aheadofprint
Résumé
There are known disparities in the treatment of infectious diseases. However, disparities in treatment of complicated urinary tract infections (UTIs) are largely uninvestigated. We characterized UTI treatment among males in Veterans Affairs (VA) outpatient settings by age, race, and ethnicity and identified demographic characteristics predictive of recommended first-choice antibiotic therapy. We conducted a national, retrospective cohort study of male VA patients diagnosed with a UTI and dispensed an outpatient antibiotic from January 2010 through December 2020. Recommended first-choice therapy for complicated UTI was defined as use of a recommended first-line antibiotic drug choice regardless of area of involvement (ciprofloxacin, levofloxacin, or sulfamethoxazole/trimethoprim) and a recommended duration of 7 to 10 days of therapy. Multivariable models were used to identify demographic predictors of recommended first-choice therapy (adjusted odds ratio [aOR] > 1). We identified a total of 157,898 males diagnosed and treated for a UTI in the outpatient setting. The average antibiotic duration was 9.4 days (±standard deviation [SD] 4.6), and 47.6% of patients were treated with ciprofloxacin, 25.1% with sulfamethoxazole/trimethoprim, 7.6% with nitrofurantoin, and 6.6% with levofloxacin. Only half of the male patients (50.6%, n = 79,928) were treated with recommended first-choice therapy (first-line drug choice and appropriate duration); 77.6% (n = 122,590) were treated with a recommended antibiotic choice and 65.9% (n = 104,070) with a recommended duration. Age 18-49 years (aOR 1.07, 95% confidence interval [CI] 1.03-1.11) versus age ≥65 years was the only demographic factor predictive of recommended first-choice therapy. Nearly half of the patients included in this study did not receive recommended first-choice therapies; however, racial and ethnic disparities were not identified. Underutilization of recommended first-choice antibiotic therapy in complicated UTIs continues to be an area of focus for antimicrobial stewardship programs.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : VA Health Services Research and Development (HSR&D) Career Development Award
ID : #15-260
Organisme : VA Health Services Research and Development (HSR&D) Career Development Award
ID : #15-120
Informations de copyright
Published 2024. This article is a U.S. Government work and is in the public domain in the USA.
Références
Sanchez GV, Fleming-Dutra KE, Roberts RM, Hicks LA. Core elements of outpatient antibiotic stewardship. MMWR Recomm Rep. 2016;65(6):1-12.
Centers for Disease Control and Prevention. Outpatient antibiotic prescriptions - United States, 2022. Accessed March 1, 2024. https://www.cdc.gov/antibiotic-use/data/report-2022.html
Fleming-Dutra KE, Hersh AL, Shapiro DJ, et al. Prevalence of inappropriate antibiotic prescriptions among US ambulatory care visits, 2010-2011. JAMA. 2016;315(17):1864-1873.
King LM, Bartoces M, Fleming-Dutra KE, Roberts RM, Hicks LA. Changes in US outpatient antibiotic prescriptions from 2011-2016. Clin Infect Dis. 2020;70(3):370-377.
Gahbauer AM, Gonzales ML, Guglielmo BJ. Patterns of antibacterial use and impact of age, race/ethnicity, and geographic region on antibacterial use in an outpatient medicaid cohort. Pharmacotherapy. 2014;34(7):677-685.
Young EH, Panchal RM, Yap AG, Reveles KR. National trends in oral antibiotic prescribing in United States physician offices from 2009 to 2016. Pharmacotherapy. 2020;40(10):1012-1021.
Young EH, Strey KA, Lee GC, et al. National Disparities in antibiotic prescribing by race, ethnicity, age group, and sex in United States ambulatory care visits, 2009 to 2016. Antibiotics. 2023;12(1):51.
Young EH, Strey KA, Lee GC, Carlson TJ, Koeller JM, Reveles KR. Clostridioides difficile infection treatment and outcome disparities in a National Sample of United States hospitals. Antibiotics (Basel). 2022;11(9):1203. doi:10.3390/antibiotics11091203
Fiscella K, Sanders MR. Racial and ethnic disparities in the quality of health care. Annu Rev Public Health. 2016;37:375-394.
VHA Office of Health Equity. Health Equity Action Plan. September 27, 2019.
Goebel MC, Trautner BW, Grigoryan L. The five Ds of outpatient antibiotic stewardship for urinary tract infections. Clin Microbiol Rev. 2021;34(4):e0000320.
White AT, Clark CM, Sellick JA, Mergenhagen KA. Antibiotic stewardship targets in the outpatient setting. Am J Infect Control. 2019;47(8):858-863.
Kilbourne AM, Switzer G, Hyman K, Crowley-Matoka M, Fine MJ. Advancing health disparities research within the health care system: a conceptual framework. Am J Public Health. 2006;96(12):2113-2121.
Appaneal HJ, Caffrey AR, Lopes V, Dosa D, LaPlante KL. Antibiotic prescribing in outpatient settings: rural patients are more likely to receive fluoroquinolones and longer antibiotic courses. Antibiotics (Basel). 2023;12(2):224.
Appaneal HJ, Shireman TI, Lopes VV, et al. Poor clinical outcomes associated with suboptimal antibiotic treatment among older long-term care facility residents with urinary tract infection: a retrospective cohort study. BMC Geriatr. 2021;21(1):436.
Appaneal HJ, Caffrey AR, Lopes VV, Dosa DM, Shireman TI, LaPlante KL. Frequency and predictors of suboptimal prescribing among a cohort of older male residents with urinary tract infections. Clin Infect Dis. 2021;73(9):e2763-e2772.
Gajdács M, Ábrók M, Lázár A, Burián K. Urinary tract infections in elderly patients: a 10-year study on their epidemiology and antibiotic resistance based on the WHO Access, Watch, Reserve (AWaRe) Classification. Antibiotics (Basel). 2021;10(9):1098.
Griebling TL. Urologic diseases in america project: trends in resource use for urinary tract infections in men. J Urol. 2005;173(4):1288-1294.
Brusch J. Urinary Tract Infection (UTI) in Males Treatment & Management. 2020. Accessed February 10, 2023. https://emedicine.medscape.com/article/231574-treatment
Ray KN, Shi Z, Gidengil CA, Poon SJ, Uscher-Pines L, Mehrotra A. Antibiotic prescribing during pediatric direct-to-consumer telemedicine visits. Pediatrics. 2019;143(5):e20182491. doi:10.1542/peds.2018-2491
US Department of Agriculture. Rural-Urban Commuting Area Codes. Accessed August 17, 2020. https://www.ers.usda.gov/data-products/rural-urban-commuting-area-codes/
Nicolle LE, A.C.G. Committee*. Complicated urinary tract infection in adults. Can J Infect Dis Med Microbiol. 2005;16(6):349-360.
Nicolle LE, Bradley S, Colgan R, et al. Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. Clin Infect Dis. 2005;40(5):643-654.
Schaeffer AJ, Nicolle LE. Urinary tract infections in older men. N Engl J Med. 2016;374(22):2192.
Gupta K. Acute complicated urinary tract infection (including pyelonephritis) in adults. 2022. Accessed February 10, 2023. https://www.uptodate.com/contents/acute-complicated-urinary-tract-infection-including-pyelonephritis-in-adults
Hosmer DW, Lemeshow S. Applied Logistic Regression. 2nd ed. John Wiley & Sons, Inc; 2000.
Germanos GJ, Trautner BW, Zoorob RJ, et al. No clinical benefit to treating male urinary tract infection longer than seven days: an outpatient database study. Open forum. Infect Dis. 2019;6(6):ofz216.
Ho JM, Juurlink DN. Considerations when prescribing trimethoprim-sulfamethoxazole. CMAJ. 2011;183(16):1851-1858.
Blommaert A, Coenen S, Gielen B, Goossens H, Hens N, Beutels P. Patient and prescriber determinants for the choice between amoxicillin and broader-spectrum antibiotics: a nationwide prescription-level analysis. J Antimicrob Chemother. 2013;68(10):2383-2392.
Beyer I, Mergam A, Benoit F, Theunissen C, Pepersack T. Management of urinary tract infections in the elderly. Z Gerontol Geriatr. 2001;34(2):153-157.
Scott MM, Liang SY. Infections in older adults. Emerg Med Clin North Am. 2021;39(2):379-394.
Alternatives to fluoroquinolones. JAMA. 2016;316(13):1404-1405.
Fralick M, Macdonald EM, Gomes T, et al. Co-trimoxazole and sudden death in patients receiving inhibitors of renin-angiotensin system: population based study. BMJ. 2014;349:g6196.
Antoniou T, Hollands S, Macdonald EM, Gomes T, Mamdani MM, Juurlink DN. Trimethoprim-sulfamethoxazole and risk of sudden death among patients taking spironolactone. CMAJ. 2015;187(4):E138-E143.
Baggio D, Ananda-Rajah MR. Fluoroquinolone antibiotics and adverse events. Aust Prescr. 2021;44(5):161-164.
FDA. FDA warns about increased risk of ruptures or tears in the aorta blood vessel with fluoroquinolone antibiotics in certain patients. Accessed May 10, 2017.
Inouye SK. Creating an anti-ageist healthcare system to improve care for our current and future selves. Nature Aging. 2021;1(2):150-152.
Arias SA, Boudreaux ED, Segal DL, Miller I, Camargo CA Jr, Betz ME. Disparities in treatment of older adults with suicide risk in the emergency department. J Am Geriatr Soc. 2017;65(10):2272-2277.
Kallen AJ, Welch HG, Sirovich BE. Current antibiotic therapy for isolated urinary tract infections in women. Arch Intern Med. 2006;166(6):635-639.
Langner JL, Chiang KF, Stafford RS. Current prescribing practices and guideline concordance for the treatment of uncomplicated urinary tract infections in women. Am J Obstet Gynecol. 2021;225(3):272.e1-272.e11.
Kikuchi JY, Banaag A, Koehlmoos TP. Antibiotic prescribing patterns and guideline concordance for uncomplicated urinary tract infections among adult women in the US military health system. JAMA Netw Open. 2022;5(8):e2225730.
Goodman KE, Baghdadi JD, Magder LS, et al. Patterns, predictors, and Intercenter variability in empiric gram-negative antibiotic use across 928 United States hospitals. Clin Infect Dis. 2023;76(3):e1224-e1235.
Braveman P, Egerter S, Williams DR. The social determinants of health: coming of age. Annu Rev Public Health. 2011;32:381-398.
Bhargava A, Sharma M, Riederer K, Fukushima EA, Szpunar SM, Saravolatz L. Risk factors for in-hospital mortality from coronavirus disease 2019 infection among black patients-an Urban Center experience. Clin Infect Dis. 2021;73(11):e4005-e4011.
Casey JA, Rudolph KE, Robinson SC, et al. Sociodemographic inequalities in urinary tract infection in 2 large California health systems. Open Forum Infect Dis. 2021;8(6):ofab276.
Kondo K, Low A, Everson T, et al. Prevalence of and Interventions to Reduce Health Disparities in Vulnerable Veteran Populations: A Map of the Evidence. Department of Veterans Affairs (US); 2017.
Razjouyan J, Helmer DA, Li A, et al. Differences in COVID-19-related testing and healthcare utilization by race and ethnicity in the veterans health administration. J Racial Ethn Health Disparities. 2022;9(2):519-526.
Tiako MJN, Forman HP, Nuñez-Smith M. Racial health disparities, COVID-19, and a way forward for US health systems. J Hosp Med. 2021;16(1):50-52.
Wiltz JL, Feehan AK, Molinari NAM, et al. Racial and ethnic disparities in receipt of medications for treatment of COVID-19 - United States, march 2020-august 2021. MMWR Morb Mortal Wkly Rep. 2022;71(3):96-102.
Sinawe H, Casadesus D. Urine Culture. StatPearls Publishing; 2022.