Outpatient treatment and clinical outcomes of bacteriuria in veterans: A retrospective cohort analysis
Abstract Objective: To conduct a contemporary detailed assessment of outpatient antibiotic prescribing and outcomes for positive urine cultures in a mixed-sex cohort. Design: Multicenter retrospective cohort review. Setting: The study was conducted using data from 31 Veterans’ Affairs medical...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Cambridge University Press
2022-01-01
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| Series: | Antimicrobial Stewardship & Healthcare Epidemiology |
| Online Access: | https://www.cambridge.org/core/product/identifier/S2732494X22002856/type/journal_article |
| _version_ | 1811157200274456576 |
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| author | Suzette A. Rovelsky Michelle Vu Alexis K. Barrett Kenneth Bukowski Xiangming Wei Muriel Burk Makoto Jones Kelly Echevarria Katie J Suda Francesca Cunningham Karl J Madaras-Kelly for the UTI Management Improvement Group |
| author_facet | Suzette A. Rovelsky Michelle Vu Alexis K. Barrett Kenneth Bukowski Xiangming Wei Muriel Burk Makoto Jones Kelly Echevarria Katie J Suda Francesca Cunningham Karl J Madaras-Kelly for the UTI Management Improvement Group |
| author_sort | Suzette A. Rovelsky |
| collection | DOAJ |
| description |
Abstract
Objective:
To conduct a contemporary detailed assessment of outpatient antibiotic prescribing and outcomes for positive urine cultures in a mixed-sex cohort.
Design:
Multicenter retrospective cohort review.
Setting:
The study was conducted using data from 31 Veterans’ Affairs medical centers.
Patients:
Outpatient adults with positive urine cultures.
Methods:
From 2016 to 2019, data were extracted through a nationwide database and manual chart review. Positive urine cultures were reviewed at the chart, clinician, and aggregate levels. Cases were classified as cystitis, pyelonephritis, or asymptomatic bacteriuria (ASB) based upon documented signs and symptoms. Preferred therapy definitions were applied for subdiagnoses: ASB (no antibiotics), cystitis (trimethoprim-sulfamethoxazole, nitrofurantoin, β-lactams), and pyelonephritis (trimethoprim-sulfamethoxazole, fluoroquinolone). Outcomes included 30-day clinical failure or hospitalization. Odds ratios for outcomes between treatments were estimated using logistic regression.
Results:
Of 3,255 cases reviewed, ASB was identified in 1,628 cases (50%), cystitis was identified in 1,156 cases (36%), and pyelonephritis was identified in 471 cases (15%). Of all 2,831 cases, 1,298 (46%) received preferred therapy selection and duration for cases where it could be defined. The most common antibiotic class prescribed was a fluoroquinolone (34%). Patients prescribed preferred therapy had lower odds of clinical failure: preferred (8%) versus nonpreferred (10%) (unadjusted OR, 0.74; 95% confidence interval [CI], 0.58–0.95; P = .018). They also had lower odds of 30-day hospitalization: preferred therapy (3%) versus nonpreferred therapy (5%) (unadjusted OR, 0.55; 95% CI, 0.37–0.81; P = .002). Odds of clinical treatment failure or hospitalization was higher for β-lactams relative to ciprofloxacin (unadjusted OR, 1.89; 95% CI, 1.23–2.90; P = .002).
Conclusions:
Clinicians prescribed preferred therapy 46% of the time. Those prescribed preferred therapy had lower odds of clinical failure and of being hospitalized.
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| first_indexed | 2024-04-10T05:03:08Z |
| format | Article |
| id | doaj.art-f17cb797cc354788ad26fc7604ed22e8 |
| institution | Directory Open Access Journal |
| issn | 2732-494X |
| language | English |
| last_indexed | 2024-04-10T05:03:08Z |
| publishDate | 2022-01-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | Antimicrobial Stewardship & Healthcare Epidemiology |
| spelling | doaj.art-f17cb797cc354788ad26fc7604ed22e82023-03-09T12:28:16ZengCambridge University PressAntimicrobial Stewardship & Healthcare Epidemiology2732-494X2022-01-01210.1017/ash.2022.285Outpatient treatment and clinical outcomes of bacteriuria in veterans: A retrospective cohort analysisSuzette A. Rovelsky0https://orcid.org/0000-0002-5569-7576Michelle Vu1https://orcid.org/0000-0003-0795-1688Alexis K. Barrett2https://orcid.org/0000-0002-9339-5392Kenneth Bukowski3Xiangming Wei4Muriel Burk5Makoto Jones6Kelly Echevarria7Katie J Suda8Francesca Cunningham9Karl J Madaras-Kelly10https://orcid.org/0000-0001-9933-4120for the UTI Management Improvement GroupPharmacy Service, Boise Veterans’ Affairs Medical Center, Boise, Idaho Pharmacy Service, White River Veterans’ Affairs Medical Center, White River Junction, VermontCenter for Medication Safety (VA MedSAFE), Hines Veterans’ Affairs Medical Center, Chicago, Illinois Optum Life Sciences-HEOR, Eden Prairie, MinnesotaCenter for Medication Safety (VA MedSAFE), Hines Veterans’ Affairs Medical Center, Chicago, IllinoisCenter for Medication Safety (VA MedSAFE), Hines Veterans’ Affairs Medical Center, Chicago, IllinoisCenter for Medication Safety (VA MedSAFE), Hines Veterans’ Affairs Medical Center, Chicago, IllinoisCenter for Medication Safety (VA MedSAFE), Hines Veterans’ Affairs Medical Center, Chicago, IllinoisGeorge E. Wahlen Medical Center, Salt Lake City, UtahVeterans’ Affairs Pharmacy Benefits Management, Hines Veterans’ Affairs Medical Center, Chicago, IllinoisPittsburgh Veterans’ Affairs Medical Center, Pittsburgh, Pennsylvania Department of Medicine, University of Pittsburgh, Pittsburgh, PennsylvaniaCenter for Medication Safety (VA MedSAFE), Hines Veterans’ Affairs Medical Center, Chicago, IllinoisPharmacy Service, Boise Veterans’ Affairs Medical Center, Boise, Idaho College of Pharmacy, Idaho State University, Meridian, Idaho Abstract Objective: To conduct a contemporary detailed assessment of outpatient antibiotic prescribing and outcomes for positive urine cultures in a mixed-sex cohort. Design: Multicenter retrospective cohort review. Setting: The study was conducted using data from 31 Veterans’ Affairs medical centers. Patients: Outpatient adults with positive urine cultures. Methods: From 2016 to 2019, data were extracted through a nationwide database and manual chart review. Positive urine cultures were reviewed at the chart, clinician, and aggregate levels. Cases were classified as cystitis, pyelonephritis, or asymptomatic bacteriuria (ASB) based upon documented signs and symptoms. Preferred therapy definitions were applied for subdiagnoses: ASB (no antibiotics), cystitis (trimethoprim-sulfamethoxazole, nitrofurantoin, β-lactams), and pyelonephritis (trimethoprim-sulfamethoxazole, fluoroquinolone). Outcomes included 30-day clinical failure or hospitalization. Odds ratios for outcomes between treatments were estimated using logistic regression. Results: Of 3,255 cases reviewed, ASB was identified in 1,628 cases (50%), cystitis was identified in 1,156 cases (36%), and pyelonephritis was identified in 471 cases (15%). Of all 2,831 cases, 1,298 (46%) received preferred therapy selection and duration for cases where it could be defined. The most common antibiotic class prescribed was a fluoroquinolone (34%). Patients prescribed preferred therapy had lower odds of clinical failure: preferred (8%) versus nonpreferred (10%) (unadjusted OR, 0.74; 95% confidence interval [CI], 0.58–0.95; P = .018). They also had lower odds of 30-day hospitalization: preferred therapy (3%) versus nonpreferred therapy (5%) (unadjusted OR, 0.55; 95% CI, 0.37–0.81; P = .002). Odds of clinical treatment failure or hospitalization was higher for β-lactams relative to ciprofloxacin (unadjusted OR, 1.89; 95% CI, 1.23–2.90; P = .002). Conclusions: Clinicians prescribed preferred therapy 46% of the time. Those prescribed preferred therapy had lower odds of clinical failure and of being hospitalized. https://www.cambridge.org/core/product/identifier/S2732494X22002856/type/journal_article |
| spellingShingle | Suzette A. Rovelsky Michelle Vu Alexis K. Barrett Kenneth Bukowski Xiangming Wei Muriel Burk Makoto Jones Kelly Echevarria Katie J Suda Francesca Cunningham Karl J Madaras-Kelly for the UTI Management Improvement Group Outpatient treatment and clinical outcomes of bacteriuria in veterans: A retrospective cohort analysis Antimicrobial Stewardship & Healthcare Epidemiology |
| title | Outpatient treatment and clinical outcomes of bacteriuria in veterans: A retrospective cohort analysis |
| title_full | Outpatient treatment and clinical outcomes of bacteriuria in veterans: A retrospective cohort analysis |
| title_fullStr | Outpatient treatment and clinical outcomes of bacteriuria in veterans: A retrospective cohort analysis |
| title_full_unstemmed | Outpatient treatment and clinical outcomes of bacteriuria in veterans: A retrospective cohort analysis |
| title_short | Outpatient treatment and clinical outcomes of bacteriuria in veterans: A retrospective cohort analysis |
| title_sort | outpatient treatment and clinical outcomes of bacteriuria in veterans a retrospective cohort analysis |
| url | https://www.cambridge.org/core/product/identifier/S2732494X22002856/type/journal_article |
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