159. Prescribing without Guidance: Antibiotic Prescribing for Male Urinary Tract Infection (UTI) in Primary Care
Session: Poster Abstract Session: Antimicrobial Stewardship: Current State and Future Opportunities
Thursday, October 8, 2015
Room: Poster Hall
Posters
  • Holmer_Male UTI_ IDWeek 2015_Poster_10.2.15_FINAL.pdf (230.9 kB)
  • Background: Little evidence exists regarding the best antibiotic regimen for UTI in men. Our objective was to describe current practice patterns in the treatment of male UTI in primary care clinics and evaluate the concordance between antibiotic prescribing and antibiotic susceptibility of uropathogens in men with acute UTI.

    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.

    Haley K. Holmer, MPH, Public Health and Preventive Medicine, Oregon Health & Science University, School of Medicine, Portland, OR, Miriam R. Elman, MPH, Dept. of Pharmacy Practice, Oregon State University/Oregon Health & Science University College of Pharmacy, Portland, OR, Charlesnika Evans, PhD, MPH, Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, Hines, IL, Katie J. Suda, PharmD, Center for Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, Hines, IL and Jessina C. Mcgregor, PhD, Dept. Pharmacy Practice, Oregon State University College of Pharmacy, Portland, OR; Dept. Public Health & Preventive Medicine, Oregon Health & Science University School of Medicine, Portland, OR

    Disclosures:

    H. K. Holmer, None

    M. R. Elman, None

    C. Evans, None

    K. J. Suda, None

    J. C. Mcgregor, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.