Most patients who present to the emergency department with an uncomplicated urinary tract infection (UTI) do not receive the appropriate treatment recommended by the Infectious Disease Society of America (IDSA), according to research presented at the American Academy of Physician Associates (AAPA) national conference held May 20 to 24, 2023, in Nashville, Tennessee.
The IDSA guidelines indicate that the first line of treatment for patients with an uncomplicated UTI is 100 mg nitrofurantoin given twice daily for 5 days. Between September 2021 and February 2022, researchers conducted a retrospective chart review on 150 patients who presented to the University of Utah Emergency Department Urgent Care with UTI symptoms. Seventy-nine of these patients were included in the final analysis; the other 71 met at least one of the exclusion criteria.
Patients were included in the final analysis if they were a cis-gender woman aged 18 to 65 years and they presented with a primary complaint of dysuria, urinary hesitancy, frequency, urgency, or suprapubic pain. Patients were excluded if they were pregnant, allergic to nitrofurantoin, had a history of a UTI with a resistant pathogen, had a UTI diagnosis in the past month, had been treated with antibiotics in the past 2 weeks, had a current sexually transmitted infection, were immunocompromised, or had any symptoms of pyelonephritis. Most of the patients (87.3%) included in the final analysis had private insurance, and 10.1% were on Medicaid.
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Of the 79 patients included in the final analysis, only 16.9% received the recommended treatment according to the IDSA guidelines. Approximately 2 out of 3 patients (64.6%) were treated with nitrofurantoin, but the duration (7 days instead of 5 days) was incorrect for 76.5% of the patients treated with nitrofurantoin according to IDSA guidelines. The most commonly prescribed alternative to nitrofurantoin was cephalexin (500 mg), followed by cefluroxime (500 mg), cephalexin (500 mg), ciprofloxin (500 mg), cefpodoxime (100 mg), and fluconazole (150 mg).
The data from this retrospective chart review indicates that there is low adherence to IDSA guidelines, and room for improvement to help clinicians adhere to these guidelines. The study authors indicate that the default settings of electronic medical records (EMRs) are preset to suggest 100 mg nitrofurantoin twice daily for 7 days instead of 5, and correcting this EMR failure could improve adherence to IDSA guidelines.
Though urine cultures are not recommended by the IDSA, 70.9% of patients received a culture, of which 36.7% indicated E. coli, 11.4% had mixed flora, and 7.6% had no growth.
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References
Fasig K, Tyan K, Mason W, et. al. Advanced practice clinician antibiotic prescribing practices for the treatment of uncomplicated UTIs at the University of Utah Emergency Department Urgent Care. Presented at: AAPA national conference; May 20-24, 2023; Nashville, TN.
