Methods: This retrospective case-case-control study evaluated Veterans with SCI cared for at VA facilities from October 2012-September 2013. SCI patients continuously receiving NF for UTI prophylaxis (Case1 group) were compared to patients who had a history of at least 90 days of NF for UTI prophylaxis (Case2 group). Cases were matched to controls cared for at the same facility during the study period who had not received prophylactic treatment and had a history of ≥3 positive urine cultures. Demographics and health outcomes were compared using Chi square, Fisher Exact, and Wilcoxon-Mann-Whitney tests as appropriate; Bonferroni was used to adjust for multiple comparisons.
Results: 122 SCI patients were identified in the Case1 group (mean age=59.6+11.1; range=25-84; 89% men) and 103 in the Case2 group (mean age=61.1+13.8; range=21-92; 96% men). There was no difference in NF dose for the case groups (p=NS). Cases were matched to 277 controls (mean age=61.4+11.9; range=22-88; 95% men; p=NS). Controls had a significantly higher Charlson Index as compared to cases (p≤0.0001). The Case1 group had a significant reduction in symptomatic UTIs as compared to the Case2 group (30% vs. 55% respectively, p=0.02). Case groups were more likely to have isolates resistant to NF (p≤0.0001), while multi-drug resistant organisms (resistant to ≥3 classes) were more frequent in controls (p=0.02). Fewer Enterococcus (p=0.001) and E. coli (p=0.08) isolates were cultured in cases as compared to controls. The Case1 group had fewer positive urine cultures and less inpatient and outpatient healthcare utilization as compared to the Case2 or control groups (p≤0.02).
Conclusion: Nitrofurantoin prophylaxis may reduce symptomatic UTIs in Veterans with SCI and may be considered for patients with multiple UTI-related health care encounters.
U. C. Patel, None
K. J. Suda, None