Critchlow Elizabeth, Kuzma Alexandra, Koelper Nathanael, Agrawal Surbhi, Dutcher Lauren, Arya Lily
Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA, USA.
Department of Obstetrics and Gynecology, Crozer Health, Upland, PA, USA.
Int Urogynecol J. 2025 Apr 29. doi: 10.1007/s00192-025-06141-x.
Our aim was to describe the rate of unnecessary antibiotic prescriptions across specialties and the frequency of clinical scenarios in which the unnecessary antibiotics were prescribed in older female patients with recurrent urinary tract infections (UTI).
This was a retrospective cohort study of female patients 65 or older with a clinical diagnosis of recurrent UTI. An unnecessary antibiotic was defined as an antibiotic prescribed (i) for asymptomatic bacteriuria (positive culture in the absence of UTI-specific symptoms), (ii) in the absence of UTI-specific symptoms, or (iii) in the presence of documented negative urine culture or negative pyuria. Data on clinical scenarios during episodes when an unnecessary antibiotic was prescribed (such as symptom documentation, urine testing) were extracted and described.
The overall rate of unnecessary antibiotics across 454 episodes of antibiotic prescriptions in 175 older female patients with recurrent UTI was 41% and did not significantly differ between specialties (primary care 45%, urogynecology 41%, obstetrics-gynecology 29%, urology 28%, urgent care 27%, p = 0.06). The commonest clinical scenario during which an unnecessary antibiotic was prescribed was absence of documented UTI-specific symptoms (60%) followed by asymptomatic bacteriuria (46%). Other clinical scenarios associated with unnecessary antibiotics included antibiotics prescribed with documented negative pyuria (32%) or negative urine culture (18%). In 11% of episodes, antibiotics were prescribed without any documented UTI-specific symptom and without any testing.
Inadequate symptom documentation and inappropriate urine testing contribute to a high rate of unnecessary antibiotic prescribing in older female patients with recurrent UTI. Clinical decision support tools that address these gaps could promote antibiotic stewardship.
我们的目的是描述各专科中不必要抗生素处方的比例，以及老年复发性尿路感染女性患者开具不必要抗生素的临床情况频率。
这是一项对65岁及以上临床诊断为复发性尿路感染的女性患者的回顾性队列研究。不必要抗生素被定义为：(i) 用于无症状菌尿（无尿路感染特异性症状但培养阳性）；(ii) 在无尿路感染特异性症状时开具；(iii) 在有记录显示尿培养阴性或脓尿阴性时开具。提取并描述了开具不必要抗生素期间（如症状记录、尿液检测）的临床情况数据。
175例老年复发性尿路感染女性患者的454次抗生素处方中，不必要抗生素的总体比例为41%，各专科之间无显著差异（初级保健45%，泌尿妇科41%，妇产科29%，泌尿外科28%，紧急护理27%，p = 0.06）。开具不必要抗生素最常见的临床情况是无记录的尿路感染特异性症状（60%），其次是无症状菌尿（46%）。与不必要抗生素相关的其他临床情况包括开具抗生素时记录有脓尿阴性（32%）或尿培养阴性（18%）。在11%的病例中，开具抗生素时既无记录的尿路感染特异性症状，也未进行任何检测。
症状记录不充分和尿液检测不当导致老年复发性尿路感染女性患者不必要抗生素处方率较高。解决这些差距的临床决策支持工具可促进抗生素管理。
