The clinical rate of antibiotic change following empiric treatment for suspected urinary tract infections
Purpose To determine the rate of antibiotic change in an outpatient setting following empiric treatment of culture proven UTI and to identify risk factors associated with change. Methods Patients with suspected UTI and urine culture were reviewed (January 2016–June 2016). Those with a positive cultu...
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| Veröffentlicht in: | International urology and nephrology 2020-03, Vol.52 (3), p.431-436 |
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| creator | Dokter, Jonathan Tennyson, Lauren E. Nguyen, Laura Han, Esther Sirls, Larry T. |
| description | Purpose
To determine the rate of antibiotic change in an outpatient setting following empiric treatment of culture proven UTI and to identify risk factors associated with change.
Methods
Patients with suspected UTI and urine culture were reviewed (January 2016–June 2016). Those with a positive culture were categorized by whether or not they were treated empirically. Empiric treatment was evaluated for associations with clinical–demographic data, symptoms and urinalysis (UA). Antibiotic change was evaluated with clinical–demographic data, urine culture, and resistance patterns.
Results
916 urine cultures (636 patients) were included. 391 (43%) cultures were positive, and 164 (42%) were treated empirically. Clinical–demographic data did not differ between groups. Those treated empirically had more documented UTI symptoms (93 vs 58%,
P
|
| doi_str_mv | 10.1007/s11255-019-02327-7 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_journals_2373446872</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2373446872</sourcerecordid><originalsourceid>FETCH-LOGICAL-c375t-b6d566d2ea8d6bd81e5822d310381a0d416ecb468841df510f662cd0c887ae713</originalsourceid><addsrcrecordid>eNp9kE1PGzEQhq0KVELgD_RQWeK8MGPv2s6xQqVFisQlnC2v7Q1GG29qe1Xx73FJoDdOI837MaOHkG8I1wggbzIi67oGcNUA40w28gtZYCd5wzrVnpAFcMAGBeNn5DznZwBYKYCv5IyjWCFysSBh8-SpHUMM1ow0meLpNFATS-jDVIKl9snErafDNI7T3xC31O_2IVWhJG_KzsdStUTznPfeFu_onEI06aXqxhYa4lDXYYr5gpwOZsz-8jiX5PHu5-b2d7N--HV_-2PdWC670vTCdUI45o1yoncKfacYcxyBKzTgWhTe9q1QqkU3dAiDEMw6sEpJ4yXyJbk69O7T9Gf2uejnaU6xntSMS97WqGTVxQ4um6ackx_0PoVd_Vsj6H909YGurnT1G10ta-j7sXrud959RN5xVgM_GHKVKrb0__Ynta__YYZU</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2373446872</pqid></control><display><type>article</type><title>The clinical rate of antibiotic change following empiric treatment for suspected urinary tract infections</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Dokter, Jonathan ; Tennyson, Lauren E. ; Nguyen, Laura ; Han, Esther ; Sirls, Larry T.</creator><creatorcontrib>Dokter, Jonathan ; Tennyson, Lauren E. ; Nguyen, Laura ; Han, Esther ; Sirls, Larry T.</creatorcontrib><description>Purpose
To determine the rate of antibiotic change in an outpatient setting following empiric treatment of culture proven UTI and to identify risk factors associated with change.
Methods
Patients with suspected UTI and urine culture were reviewed (January 2016–June 2016). Those with a positive culture were categorized by whether or not they were treated empirically. Empiric treatment was evaluated for associations with clinical–demographic data, symptoms and urinalysis (UA). Antibiotic change was evaluated with clinical–demographic data, urine culture, and resistance patterns.
Results
916 urine cultures (636 patients) were included. 391 (43%) cultures were positive, and 164 (42%) were treated empirically. Clinical–demographic data did not differ between groups. Those treated empirically had more documented UTI symptoms (93 vs 58%,
P
< 0.001), and UA abnormalities including positive nitrites (51 vs 29%,
P
< 0.001), 3 + leukocyte esterase (27 vs 19%,
P
= 0.002) and 3 + blood (13 vs 4%,
P
= 0.005). Of those treated empirically, 42/164 (26%) required an antibiotic change, and this was associated with immunosuppression (12 vs 2%,
P
= 0.027) resistance to > 3 antibiotics (33 vs 20%,
P
= 0.039) and also resistance to fluoroquinolone (50 vs 30%,
P
= 0.016), monobactam (19 vs 7%
P
= 0.042) and TMP–SMX (52 vs 19%,
P
< 0.001).
Conclusions
Almost one-quarter of patients treated empirically required antibiotic change. This was driven largely by bacterial resistance. New technologies allowing rapid bacterial identification and sensitivity may improve patient care.</description><identifier>ISSN: 0301-1623</identifier><identifier>EISSN: 1573-2584</identifier><identifier>DOI: 10.1007/s11255-019-02327-7</identifier><identifier>PMID: 31691136</identifier><language>eng</language><publisher>Dordrecht: Springer Netherlands</publisher><subject>Anti-Bacterial Agents - administration & dosage ; Anti-Bacterial Agents - adverse effects ; Anti-Bacterial Agents - classification ; Antibiotics ; Antimicrobial agents ; Drug Resistance, Microbial ; Drug Substitution - adverse effects ; Drug Substitution - methods ; Drug Substitution - statistics & numerical data ; Early Diagnosis ; Esterase ; Female ; Health risk assessment ; Humans ; Immunosuppression ; Male ; Medicine ; Medicine & Public Health ; Microbial Sensitivity Tests - methods ; Middle Aged ; Nephrology ; Nitrites ; Outcome Assessment, Health Care ; Patients ; Quality Improvement ; Risk Factors ; Urinalysis ; Urinalysis - methods ; Urinary tract ; Urinary tract infections ; Urinary Tract Infections - diagnosis ; Urinary Tract Infections - drug therapy ; Urinary Tract Infections - microbiology ; Urine ; Urology ; Urology - Original Paper</subject><ispartof>International urology and nephrology, 2020-03, Vol.52 (3), p.431-436</ispartof><rights>Springer Nature B.V. 2019</rights><rights>International Urology and Nephrology is a copyright of Springer, (2019). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-b6d566d2ea8d6bd81e5822d310381a0d416ecb468841df510f662cd0c887ae713</citedby><cites>FETCH-LOGICAL-c375t-b6d566d2ea8d6bd81e5822d310381a0d416ecb468841df510f662cd0c887ae713</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s11255-019-02327-7$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s11255-019-02327-7$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31691136$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Dokter, Jonathan</creatorcontrib><creatorcontrib>Tennyson, Lauren E.</creatorcontrib><creatorcontrib>Nguyen, Laura</creatorcontrib><creatorcontrib>Han, Esther</creatorcontrib><creatorcontrib>Sirls, Larry T.</creatorcontrib><title>The clinical rate of antibiotic change following empiric treatment for suspected urinary tract infections</title><title>International urology and nephrology</title><addtitle>Int Urol Nephrol</addtitle><addtitle>Int Urol Nephrol</addtitle><description>Purpose
To determine the rate of antibiotic change in an outpatient setting following empiric treatment of culture proven UTI and to identify risk factors associated with change.
Methods
Patients with suspected UTI and urine culture were reviewed (January 2016–June 2016). Those with a positive culture were categorized by whether or not they were treated empirically. Empiric treatment was evaluated for associations with clinical–demographic data, symptoms and urinalysis (UA). Antibiotic change was evaluated with clinical–demographic data, urine culture, and resistance patterns.
Results
916 urine cultures (636 patients) were included. 391 (43%) cultures were positive, and 164 (42%) were treated empirically. Clinical–demographic data did not differ between groups. Those treated empirically had more documented UTI symptoms (93 vs 58%,
P
< 0.001), and UA abnormalities including positive nitrites (51 vs 29%,
P
< 0.001), 3 + leukocyte esterase (27 vs 19%,
P
= 0.002) and 3 + blood (13 vs 4%,
P
= 0.005). Of those treated empirically, 42/164 (26%) required an antibiotic change, and this was associated with immunosuppression (12 vs 2%,
P
= 0.027) resistance to > 3 antibiotics (33 vs 20%,
P
= 0.039) and also resistance to fluoroquinolone (50 vs 30%,
P
= 0.016), monobactam (19 vs 7%
P
= 0.042) and TMP–SMX (52 vs 19%,
P
< 0.001).
Conclusions
Almost one-quarter of patients treated empirically required antibiotic change. This was driven largely by bacterial resistance. New technologies allowing rapid bacterial identification and sensitivity may improve patient care.</description><subject>Anti-Bacterial Agents - administration & dosage</subject><subject>Anti-Bacterial Agents - adverse effects</subject><subject>Anti-Bacterial Agents - classification</subject><subject>Antibiotics</subject><subject>Antimicrobial agents</subject><subject>Drug Resistance, Microbial</subject><subject>Drug Substitution - adverse effects</subject><subject>Drug Substitution - methods</subject><subject>Drug Substitution - statistics & numerical data</subject><subject>Early Diagnosis</subject><subject>Esterase</subject><subject>Female</subject><subject>Health risk assessment</subject><subject>Humans</subject><subject>Immunosuppression</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Microbial Sensitivity Tests - methods</subject><subject>Middle Aged</subject><subject>Nephrology</subject><subject>Nitrites</subject><subject>Outcome Assessment, Health Care</subject><subject>Patients</subject><subject>Quality Improvement</subject><subject>Risk Factors</subject><subject>Urinalysis</subject><subject>Urinalysis - methods</subject><subject>Urinary tract</subject><subject>Urinary tract infections</subject><subject>Urinary Tract Infections - diagnosis</subject><subject>Urinary Tract Infections - drug therapy</subject><subject>Urinary Tract Infections - microbiology</subject><subject>Urine</subject><subject>Urology</subject><subject>Urology - Original Paper</subject><issn>0301-1623</issn><issn>1573-2584</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kE1PGzEQhq0KVELgD_RQWeK8MGPv2s6xQqVFisQlnC2v7Q1GG29qe1Xx73FJoDdOI837MaOHkG8I1wggbzIi67oGcNUA40w28gtZYCd5wzrVnpAFcMAGBeNn5DznZwBYKYCv5IyjWCFysSBh8-SpHUMM1ow0meLpNFATS-jDVIKl9snErafDNI7T3xC31O_2IVWhJG_KzsdStUTznPfeFu_onEI06aXqxhYa4lDXYYr5gpwOZsz-8jiX5PHu5-b2d7N--HV_-2PdWC670vTCdUI45o1yoncKfacYcxyBKzTgWhTe9q1QqkU3dAiDEMw6sEpJ4yXyJbk69O7T9Gf2uejnaU6xntSMS97WqGTVxQ4um6ackx_0PoVd_Vsj6H909YGurnT1G10ta-j7sXrud959RN5xVgM_GHKVKrb0__Ynta__YYZU</recordid><startdate>20200301</startdate><enddate>20200301</enddate><creator>Dokter, Jonathan</creator><creator>Tennyson, Lauren E.</creator><creator>Nguyen, Laura</creator><creator>Han, Esther</creator><creator>Sirls, Larry T.</creator><general>Springer Netherlands</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QP</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope></search><sort><creationdate>20200301</creationdate><title>The clinical rate of antibiotic change following empiric treatment for suspected urinary tract infections</title><author>Dokter, Jonathan ; Tennyson, Lauren E. ; Nguyen, Laura ; Han, Esther ; Sirls, Larry T.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-b6d566d2ea8d6bd81e5822d310381a0d416ecb468841df510f662cd0c887ae713</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Anti-Bacterial Agents - administration & dosage</topic><topic>Anti-Bacterial Agents - adverse effects</topic><topic>Anti-Bacterial Agents - classification</topic><topic>Antibiotics</topic><topic>Antimicrobial agents</topic><topic>Drug Resistance, Microbial</topic><topic>Drug Substitution - adverse effects</topic><topic>Drug Substitution - methods</topic><topic>Drug Substitution - statistics & numerical data</topic><topic>Early Diagnosis</topic><topic>Esterase</topic><topic>Female</topic><topic>Health risk assessment</topic><topic>Humans</topic><topic>Immunosuppression</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Microbial Sensitivity Tests - methods</topic><topic>Middle Aged</topic><topic>Nephrology</topic><topic>Nitrites</topic><topic>Outcome Assessment, Health Care</topic><topic>Patients</topic><topic>Quality Improvement</topic><topic>Risk Factors</topic><topic>Urinalysis</topic><topic>Urinalysis - methods</topic><topic>Urinary tract</topic><topic>Urinary tract infections</topic><topic>Urinary Tract Infections - diagnosis</topic><topic>Urinary Tract Infections - drug therapy</topic><topic>Urinary Tract Infections - microbiology</topic><topic>Urine</topic><topic>Urology</topic><topic>Urology - Original Paper</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Dokter, Jonathan</creatorcontrib><creatorcontrib>Tennyson, Lauren E.</creatorcontrib><creatorcontrib>Nguyen, Laura</creatorcontrib><creatorcontrib>Han, Esther</creatorcontrib><creatorcontrib>Sirls, Larry T.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><jtitle>International urology and nephrology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Dokter, Jonathan</au><au>Tennyson, Lauren E.</au><au>Nguyen, Laura</au><au>Han, Esther</au><au>Sirls, Larry T.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The clinical rate of antibiotic change following empiric treatment for suspected urinary tract infections</atitle><jtitle>International urology and nephrology</jtitle><stitle>Int Urol Nephrol</stitle><addtitle>Int Urol Nephrol</addtitle><date>2020-03-01</date><risdate>2020</risdate><volume>52</volume><issue>3</issue><spage>431</spage><epage>436</epage><pages>431-436</pages><issn>0301-1623</issn><eissn>1573-2584</eissn><abstract>Purpose
To determine the rate of antibiotic change in an outpatient setting following empiric treatment of culture proven UTI and to identify risk factors associated with change.
Methods
Patients with suspected UTI and urine culture were reviewed (January 2016–June 2016). Those with a positive culture were categorized by whether or not they were treated empirically. Empiric treatment was evaluated for associations with clinical–demographic data, symptoms and urinalysis (UA). Antibiotic change was evaluated with clinical–demographic data, urine culture, and resistance patterns.
Results
916 urine cultures (636 patients) were included. 391 (43%) cultures were positive, and 164 (42%) were treated empirically. Clinical–demographic data did not differ between groups. Those treated empirically had more documented UTI symptoms (93 vs 58%,
P
< 0.001), and UA abnormalities including positive nitrites (51 vs 29%,
P
< 0.001), 3 + leukocyte esterase (27 vs 19%,
P
= 0.002) and 3 + blood (13 vs 4%,
P
= 0.005). Of those treated empirically, 42/164 (26%) required an antibiotic change, and this was associated with immunosuppression (12 vs 2%,
P
= 0.027) resistance to > 3 antibiotics (33 vs 20%,
P
= 0.039) and also resistance to fluoroquinolone (50 vs 30%,
P
= 0.016), monobactam (19 vs 7%
P
= 0.042) and TMP–SMX (52 vs 19%,
P
< 0.001).
Conclusions
Almost one-quarter of patients treated empirically required antibiotic change. This was driven largely by bacterial resistance. New technologies allowing rapid bacterial identification and sensitivity may improve patient care.</abstract><cop>Dordrecht</cop><pub>Springer Netherlands</pub><pmid>31691136</pmid><doi>10.1007/s11255-019-02327-7</doi><tpages>6</tpages></addata></record> |
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| ispartof | International urology and nephrology, 2020-03, Vol.52 (3), p.431-436 |
| issn | 0301-1623 1573-2584 |
| language | eng |
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| source | MEDLINE; SpringerLink Journals - AutoHoldings |
| subjects | Anti-Bacterial Agents - administration & dosage Anti-Bacterial Agents - adverse effects Anti-Bacterial Agents - classification Antibiotics Antimicrobial agents Drug Resistance, Microbial Drug Substitution - adverse effects Drug Substitution - methods Drug Substitution - statistics & numerical data Early Diagnosis Esterase Female Health risk assessment Humans Immunosuppression Male Medicine Medicine & Public Health Microbial Sensitivity Tests - methods Middle Aged Nephrology Nitrites Outcome Assessment, Health Care Patients Quality Improvement Risk Factors Urinalysis Urinalysis - methods Urinary tract Urinary tract infections Urinary Tract Infections - diagnosis Urinary Tract Infections - drug therapy Urinary Tract Infections - microbiology Urine Urology Urology - Original Paper |
| title | The clinical rate of antibiotic change following empiric treatment for suspected urinary tract infections |
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