1322. Urinary Tract Infection in Male Veterans: Treatment Patterns and Outcomes
Session: Oral Abstract Session: Clinical Management of Infectious Disease
Saturday, October 20, 2012: 11:30 AM
Room: SDCC 26 AB
Background:

Lengthier antimicrobial therapy is associated with increased costs, antimicrobial resistance, and adverse drug events. Therefore, establishing minimum effective antimicrobial treatment durations is an important public health goal. The optimal treatment duration and current treatment patterns for urinary tract infection in men (hereafter, male UTI) are unknown. We used Veterans Affairs (VA) administrative data to study male UTI treatment and outcomes.

Methods:

Male UTI episodes in the VA system (Fiscal Year 2009) were identified by combining International Classification of Diseases, 9th Revision codes with UTI-relevant antimicrobial prescriptions. Episodes were categorized as index, early recurrence (<30 days), and late recurrence (≥30 days) cases. Drug name, treatment duration, and outcomes (recurrence and Clostridium difficileinfection [CDI] over 12 months) were recorded for index cases. Demographic, clinical, and treatment characteristics were assessed for associations with outcomes in univariate and multivariate analysis.

Results:

Among 4,854,765 outpatient male veterans, 39,149 male UTI episodes involving 33,336 unique patients were identified, including 33,336 (85.2%) index cases, 1,772 (4.5%) early recurrences, and 4,041 (10.3%) late recurrences. Highest-use antimicrobials were ciprofloxacin (62.7%) and trimethoprim/sulfamethoxazole (26.8%); 35.0% of subjects received shorter-duration (< 7d) and 65.0% longer-duration (≥ 7d) treatment. Of the index cases, 4.5% were followed by early recurrence and 9.9% by late recurrence. Although treatment duration was unassociated with early recurrence risk, late recurrence risk was significantly higher with longer vs. shorter-duration treatment (10.8% vs. 8.4%, P < .001), including in multivariate analysis (odds ratio, 1.20; 95% CI 1.10–1.30). Additionally, CDI risk was significantly higher with longer vs. shorter-duration treatment (0.5% vs. 0.3%, P= .02), and exhibited a similar suggestive trend in multivariate analysis (OR 1.40; 95% CI 0.96–2.06).

Conclusion:

Longer-duration treatment (≥ 7d) for male UTI was associated with no reduction in early recurrence but with increased late recurrence, and may have been associated with subsequent CDI. A randomized trial is needed to assess the benefits and harms of shorter vs. longer-duration treatment for male UTI.

Dimitri M. Drekonja, MD, MS1,2, Thomas S. Rector, PhD1, Andrea Cutting, MA3 and James R. Johnson, MD1, (1)University of Minnesota, Minneapolis, MN, (2)Minneapolis Veterans Affairs Medical Center, Minneapolis, MN, (3)Medicine, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN

Disclosures:

D. M. Drekonja, None

T. S. Rector, None

A. Cutting, None

J. R. Johnson, None

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