Murray Kristen, Shimabukuro Julianna, Khalfay Nuha, Chiang Jeffrey N, Lenore Ackerman A
David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
University of California, Los Angeles, California, USA.
Neurourol Urodyn. 2025 Feb;44(2):382-389. doi: 10.1002/nau.25598. Epub 2024 Dec 4.
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.
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).
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.
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.
虽然人们认为尿路感染（UTIs）在女性中很常见，但多达65%的UTI诊断可能不准确。为了确定改善抗生素管理的策略，我们试图确定与UTIs过度诊断和过度治疗相关的临床和实验室因素。
电子健康记录识别出2019年7月在单一医疗系统内有孤立UTI诊断代码的患者。通过人工病历审查收集人口统计学、临床和微生物学数据。利用回归分析，使用R统计软件（版本4.3.1）确定与不符合指南的UTI诊断和治疗相关的因素。
在被诊断为UTI的患者中，64%接受了抗生素治疗，尽管只有28%的患者症状符合UTI诊断标准。在急诊室（ER）环境中接受治疗的UTI诊断患者中，95%接受了抗生素治疗，而门诊患者中这一比例仅为55%。即使没有任何泌尿系统症状，急诊室中95%的患者和门诊患者中27%的患者也接受了抗生素治疗。因非定位性症状（如精神状态改变（MSC））到急诊室就诊的患者比门诊患者更有可能被诊断为UTI。
本研究结果表明，尽管患者不符合诊断标准，但仍经常被诊断为UTI并接受治疗。这种过度诊断模式导致过度治疗，尤其是在急性护理环境中，加剧了抗生素耐药性，同时对患者主要症状的评估也不完整。
