1503. No Benefit to Treating Male UTI for Longer Than 7 Days: An Outpatient Database Study. (26th November 2018)

• Record Type: Journal Article
• Authors: Germanos, George; Trautner, Barbara W; Zoorob, Roger; Drekonja, Dimitri M; Salemi, Jason; Gupta, Kalpana; Grigoryan, Larissa
• Is Part Of: Open forum infectious diseases. Volume 5(2018)Supplement 1
• Page Start: S465
• Page End: S465
• Publication Date: 2018-11-26
• Subjects: Communicable diseases -- Periodicals; Medical microbiology -- Periodicals; Infection -- Periodicals; 616.9
• DOI: 10.1093/ofid/ofy210.1332
• Languages: English
• ISSNs: 2328-8957

Abstract

Abstract: Background: The optimal approach for treating outpatient male urinary tract infections (UTI) is unclear. We studied the current management of male UTI in private outpatient clinics, and evaluated antibiotic choice, treatment duration, and the outcome of recurrence of UTI. Methods: Visits for all male patients 18 years of age and older during 2011–2015 with ICD-9 Codes for UTI or associated symptoms were extracted from the EPIC Clarity Database of two family medicine, two urology and one internal medicine clinics. For each eligible visit in which an antibiotic was prescribed, we extracted data on the antibiotic used, the duration of treatment, recurrent UTI episodes, as well as patient medical and surgical history. Urologic anatomic abnormalities were an exclusion criterion (Figure 1). Results: Six hundred thirty-seven eligible visits were included for 573 unique patients (mean age 53.7 (±16.7 years)). Fluoroquinolones (FQs) were the most commonly prescribed class of antibiotic (69.7%), followed by trimethoprim-sulfamethoxazole (TMP-SMX) (21.2%), nitrofurantoin (5.3%) and β-lactams (3.8%). Use of FQ was lower in the age group of 55 years and above than < 55 years (65.4% vs. 74.6% respectively, P < 0.01). Visits in the urology department were less likely to be treated with TMP-SMX, but more likely to be treated with a β-lactam. Those with a higher Charlson Comorbodity Index were more likely to be treated with β-lactams. Nitrofurantoin use was higher for men 55 years of age and above compared with those younger (7.4% and 3% respectively, P < 0.01). Overall, the rate of recurrence was 5.6%. Recurrence was not significantly different between longer (>7 days) and shorter (≤7 days) treatments. In the multiple regression analysis, predictors of longer treatment duration included presence of complicating factors (pyelonephritis, nephrolithiasis or prostatitis), use of nitrofurantoin or β-lactams, and visits seen in urology. The presence of fever, diabetes, and BPH, as well as patient race, were not associated with antibiotic choice or treatment duration. Conclusion: Men with UTIs are most frequently prescribed FQ. Providers' choice of antibiotic was influenced by patient age and comorbidities, while treatment duration was influenced by presence of complicating factors. Disclosures: B. W. Trautner, Paratek: Consultant, Consulting fee; Zambon: Consultant, Consulting fee and Research grant. K. Gupta, Paratek Pharmaceuticals: Consultant, Consulting fee; Iterum Therapeutics: Consultant, Consulting fee; Tetraphase Pharmaceuticals: Consultant, Consulting fee. L. Grigoryan, Zambon Pharmaceuticals: Grant Investigator, Research grant.