Methods: We conducted a cross-sectional study of adult male outpatients with an acute UTI diagnosis occurring at primary care visits at Oregon Health & Science University between 2010 and 2014. Patient characteristics, encounter information, pharmacy orders, and laboratory data were extracted from electronic medical records. We summarized frequency of antibiotics prescribed ±3 days of the visit. By stratifying these by pathogen susceptibilities, we quantified the occurrence of discordant treatment and broad-spectrum antibiotic use.
Results: A total of 592 visits, representing 372 males were included. Unspecified UTI was diagnosed in 90.9% of visits, followed by acute pyelonephritis and cystitis (4.7% each). Common comorbidities included diabetes (25.3%) followed by kidney disease (23.1%) and paraplegia or quadriplegia (5.6%). Of the 374 (63.2%) encounters in which an antibiotic was prescribed, 59.1% received a fluoroquinolone (FQ), and 24.3% received trimethoprim-sulfamethoxazole (TMP/SMX). Cultures were performed in 262 (44.3%) of visits, 157 (59.9%) of which were positive. Escherichia coli was the most frequently isolated uropathogen (41.4%), followed by Enterococcus (19.4%) and Klebsiella (7.8%). In patients prescribed a FQ, 10.3% had a FQ-resistant isolate whereas among those prescribed TMP/SMX, 35.5% had a TMP/SMX-resistant isolate. In patients with isolates susceptible to both TMP/SMX and FQ, only 15.0% (12/80) were treated with TMP/SMX whereas 76.3% (61/80) received a FQ.
Conclusion: Discordance exists between pathogen susceptibility and prudent antibiotic prescribing for male UTI in the outpatient setting. The majority of isolates in our study were susceptible to TMP/SMX but few patients received TMP/SMX relative to broader spectrum agents. Clinical guidance is needed to prevent excess prescribing of FQ and other broad-spectrum agents.
H. K. Holmer,
C. Evans, None
K. J. Suda, None
J. C. Mcgregor, None
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