Unnecessary Antibiotics in Older Female Patients with Recurrent Urinary Tract Infections

Area of Science:

• Geriatric Medicine
• Infectious Diseases
• Pharmacology

Background:

• Recurrent urinary tract infections (UTIs) are common in older female patients.
• Antibiotic overuse is a significant concern in managing UTIs, contributing to antimicrobial resistance.

Purpose of the Study:

• To determine the rate of unnecessary antibiotic prescriptions in older female patients with recurrent UTIs.
• To identify clinical scenarios associated with these unnecessary prescriptions across various medical specialties.

Main Methods:

• Retrospective cohort study of female patients aged 65 and older with recurrent UTIs.
• Defined unnecessary antibiotics based on asymptomatic bacteriuria, lack of UTI symptoms, or negative diagnostic tests (urine culture, pyuria).
• Extracted and analyzed data on clinical documentation and testing during antibiotic prescription episodes.

Main Results:

• The overall rate of unnecessary antibiotic prescriptions was 41% across 454 episodes.
• Rates did not significantly differ by specialty, ranging from 27% to 45%.
• Common reasons for unnecessary prescriptions included absence of UTI symptoms (60%) and asymptomatic bacteriuria (46%).

Conclusions:

• Inadequate symptom documentation and inappropriate urine testing are key drivers of unnecessary antibiotic prescribing in this population.
• Clinical decision support tools are needed to improve antibiotic stewardship for recurrent UTIs in older women.