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Antibiotic Overprescription for "Urinary Tract Infections" Is Associated With Poor Diagnostic Stewardship and Low
Kristen Murray1, Julianna Shimabukuro2, Nuha Khalfay1
1David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
Purpose:
While urinary tract infections (UTIs) are thought to be common among women, as many as 65% of UTI diagnoses may be inaccurate. To identify strategies to improve antibiotic stewardship, we sought to determine the clinical and laboratory factors associated with overdiagnosis and overtreatment of UTIs.
Methods:
Electronic health records identified patients bearing an isolated diagnostic code for UTI within a single healthcare system during July 2019. Demographic, clinical, and microbial data were collected by manual chart review. Regression analyses were utilized to determine factors associated with guideline non-concordant UTI diagnosis and treatment utilizing R statistical software (version 4.3.1).
Results:
In patients diagnosed with UTI, 64% were treated with antibiotics despite only 28% having symptoms consistent with UTI diagnostic criteria. Of patients diagnosed with a UTI who were treated in an emergency room (ER) setting, 95% were given antibiotics compared with only 55% of patients in an outpatient setting. Even without any urinary symptoms, 95% of patients in the ER and 27% of patients in outpatient settings were treated with antibiotics. Patients who presented to the ER for non-localizing symptoms, such as mental status changes (MSC), were more likely to be diagnosed with UTI compared with those in an outpatient setting.
Conclusion:
The results of this study demonstrate that patients were frequently diagnosed with and treated for a UTI despite not meeting diagnostic criteria. This pattern of overdiagnosis leads to overtreatment, particularly in acute care settings, contributing to worsening antibiotic resistance in conjunction with incomplete evaluation of patients' primary complaints.
Insights
Many urinary tract infection (UTI) diagnoses are inaccurate, leading to unnecessary antibiotic use. This overdiagnosis and overtreatment, especially in emergency rooms, contributes to antibiotic resistance.
Area of Science:
- Infectious Diseases
- Clinical Medicine
- Public Health
Background:
- Urinary tract infections (UTIs) are common, but diagnostic accuracy is a concern.
- Antibiotic stewardship is crucial to combat rising antimicrobial resistance.
- A significant proportion of UTI diagnoses may be erroneous.
Purpose of the Study:
- To identify factors contributing to the overdiagnosis and overtreatment of UTIs.
- To inform strategies for improving antibiotic stewardship in UTI management.
- To analyze clinical and laboratory data associated with inaccurate UTI diagnoses.
Main Methods:
- Retrospective chart review of patients with UTI diagnostic codes.
- Analysis of demographic, clinical, and microbial data from electronic health records.
- Regression analyses to identify factors associated with non-concordant UTI diagnosis and treatment.
Main Results:
- 64% of patients diagnosed with UTI received antibiotics, yet only 28% met diagnostic criteria.
- Emergency room (ER) patients received antibiotics at a higher rate (95%) than outpatient settings (55%).
- Patients in ER settings, even without urinary symptoms, were frequently treated for UTI, particularly those with non-localizing symptoms like mental status changes.
Conclusions:
- Frequent overdiagnosis of UTIs leads to unnecessary antibiotic overtreatment.
- Acute care settings, especially ERs, show higher rates of UTI overdiagnosis and overtreatment.
- Incomplete patient evaluation and overdiagnosis contribute to antibiotic resistance.
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