1503. No Benefit to Treating Male UTI for Longer than 7 Days: An Outpatient Database Study
Session: Poster Abstract Session: Urinary Tract Infection
Friday, October 5, 2018
Room: S Poster Hall
Posters
  • Male UTI ID Week 2018 Poster Final.pdf (780.8 kB)
  • Background: The optimal approach for treating outpatient male urinary tract infections (UTI) is unclear. We studied the current management of male UTI in private outpatient clinics, and evaluated antibiotic choice, treatment duration, and the outcome of recurrence of UTI.

    Methods: Visits for all male patients 18 years of age and older during 2011-2015 with ICD-9 Codes for UTI or associated symptoms were extracted from the EPIC Clarity Database of 2 family medicine, 2 urology and 1 internal medicine clinics. For each eligible visit in which an antibiotic was prescribed, we extracted data on the antibiotic used, the duration of treatment, recurrent UTI episodes, as well as patient medical and surgical history. Urologic anatomic abnormalities were an exclusion criterion (Figure 1).

    Results: 637 eligible visits were included for 573 unique patients (mean age 53.7 (± 16.7 years)). Fluoroquinolones (FQ) were the most commonly prescribed class of antibiotic (69.7%), followed by trimethoprim-sulfamethoxazole (TMP-SMX) (21.2%), nitrofurantoin (5.3%) and beta-lactams (3.8%). Use of FQ was lower in the age group of 55 years and above than < 55 years (65.4% vs. 74.6% respectively, p value < 0.01). Visits in the urology department were less likely to be treated with TMP-SMX, but more likely to be treated with a beta lactam. Those with a higher Charlson Comorbodity Index were more likely to be treated with beta lactams. Nitrofurantoin use was higher for men 55 years of age and above compared with those younger (7.4% and 3% respectively, P value <0.01). Overall, the rate of recurrence was 5.6%.  Recurrence was not significantly different between longer (>7 days) and shorter (≤ 7 days) treatments. In the multiple regression analysis, predictors of longer treatment duration included presence of complicating factors (pyelonephritis, nephrolithiasis or prostatitis), use of nitrofurantoin or beta lactams, and visits seen in urology. Presence of fever, diabetes, and BPH, as well as patient race, were not associated with antibiotic choice or treatment duration.

    Conclusion: Men with UTIs are most frequently prescribed FQ. Providers’ choice of antibiotic was influenced by patient age and comorbidities, while treatment duration was influenced by presence of complicating factors.

    Figure 1:Inclusion and Exclusion Criteria

    George Germanos, MD1, Barbara W. Trautner, MD, PhD, FIDSA2, Roger Zoorob, MD, MPH1, Dimitri M. Drekonja, MD, MS, FIDSA3, Jason Salemi, PhD, MPH1, Kalpana Gupta, MD, MPH4 and Larissa Grigoryan, MD PhD1, (1)Family and Community Medicine, Baylor College of Medicine, Houston, TX, (2)Baylor College of Medicine, Houston, TX, (3)Department of Medicine, Infectious Diseases, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, (4)Infectious Diseases, VA/Boston & Boston University School of Medicine, Boston, MA

    Disclosures:

    G. Germanos, None

    B. W. Trautner, Paratek: Consultant , Consulting fee . Zambon: Consultant , Consulting fee and Research grant .

    R. Zoorob, None

    D. M. Drekonja, None

    J. Salemi, None

    K. Gupta, Paratek Pharmaceuticals: Consultant , Consulting fee . Iterum Therapeutics: Consultant , Consulting fee . Tetraphase Pharmaceuticals: Consultant , Consulting fee .

    L. Grigoryan, Zambon Pharmaceuticals: Grant Investigator , Research grant .

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.