Introduction and hypothesis
Urinary tract infections (UTIs) are one of the most common bacterial infections in women. We hypothesized that over half of those treated empirically would receive inappropriate antibiotics, those treated expectantly would have lower symptom improvement without antibiotics, and that overall progression to sequelae would be uncommon.
In this retrospective cohort study of women with UTI symptoms, we quantified the proportion who received inappropriate antibiotics in those treated empirically, defined as those with a negative urine culture or antibiotics that were changed according to culture sensitivities, and identified factors associated with symptom improvement during expectant management. Secondarily, we sought to determine the proportion of UTI sequelae in both groups. During the study time frame, a modified UTI Symptom Assessment (UTISA) questionnaire was administered at baseline and again, with a global rating for change instrument, when urine culture results were relayed.
Analyses included 152 women, mean age 66.5 (SD 15.0) years, 30 (20%) received empiric antibiotics, and 122 (80%) expectant management. At baseline, the empiric group reported greater mean scores for dysuria (p < 0.01), urgency (p < 0.01), frequency (p < 0.01), and incomplete emptying (p < 0.01). Positive culture results were reported for 16 (53%) in the empiric group and 72 (59%) in the expectant group. Inappropriate antibiotics were prescribed to 18 (60%) of the empiric group. A negative urine culture was associated with improvement in symptoms in the expectant group. No subjects experienced UTI sequelae within 30 days of initial evaluation.
In our cohort of older women with UTI symptoms, deferring antibiotics until urine culture resulted appeared to be safe and decreased the use of inappropriate antibiotics.
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Our research was supported by the National Institutes of Health through Grant Number UL1TR001857.
H.M.Z. discloses that she was a member of the Board of Directors of the American College of Obstetricians and Gynecologists; M.S.B. discloses Axonics and Hologic Research Support. No other authors have relevant financial relationships to disclose.
The University of Pittsburgh Institutional Review Board approved this research (STUDY21030043).
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Melnyk, A.I., Meckes, N., Zyczynski, H.M. et al. Antibiotic utilization and symptom improvement in a retrospective cohort of women with urinary tract infection symptoms. Int Urogynecol J (2023). https://doi.org/10.1007/s00192-023-05676-1