A Novel and Reproducible Urinary Diagnostic Framework Reduces Health Care and Antibiotic Utilization for Urinary...

An interdisciplinary clinic including specialists in infectious diseases, urology, and antimicrobial stewardship developed a standardized urinary infection diagnostic framework (UDF) for patients referred for complex urinary tract infections (UTIs).

We performed a descriptive review and evaluation of an interdisciplinary UTI clinic utilizing a standardized UDF, tracking outcomes such as infection management and resolution, health care utilization, and antibiotic exposure prior to and following the initial clinic visit. The UDF leveraged anatomic categorization (complicated or uncomplicated) and diagnostic categorization via specific symptom and culture criteria. Patients were treated according to their diagnostic categorization, including supportive care, UTI treatment and prevention therapies, and surgery, if appropriate.

A total of 216 patients were referred for complex UTIs. Sixty-eight (32%) patients referred for UTIs were found to have noninfectious syndromes. Among 70 patients with recurrent infections undergoing prevention therapy, 69% were UTI free at a mean follow-up of 4.6 months (range, 2-13). In the 20 patients with urinary bacterial persistence, a urologic nidus was identified, and a multimodal approach managed the infection in 95% (eg, removal of source or antimicrobial suppression). As compared with 1 year before the initial clinic visit, patients required fewer hospitalizations (P < .001), emergency department/urgent care visits (P < .001), and antibiotic courses and days of therapy (P < .001) for UTIs 1 year after the initial clinic visit or 1 year after source control for persistence.

An interdisciplinary UDF standardizes management of urinary complaints and can reduce hospitalizations, emergency department/urgent care visits, and antibiotic use for UTIs.