2022 VCOM Research Retreat Program

Abstracts

Retrospective Analysis of Outpatient Prescribing Patterns for Uncomplicated Cystitis in Premenopausal Women with and without an Allergy to Guideline-Recommended Antimicrobials Presenter: Amber Stroupe, DO Co-Authors: Darcy Davis*; Jaime Foushee, PharmD; Shannon Smith, DO; Samantha Rikabi*; Miles Lane Urinary tract infection (UTI) includes various bacterial infections impacting the urinary system. UTIs are differentiated based microbial infiltrate severity and anatomic location. Over 50% of women will experience one UTI in their lifetime, and approximately 10% will have UTI annually1. It is essential physicians appropriately select antibiotics for suspected UTIs given implications of inappropriate antibiotic prescribing, including but not limited to increased antimicrobial resistance within common pathogens. The most recent Infectious Diseases Society of America (IDSA) guidelines for treatment of uncomplicated cystitis provide preferred and alternative antimicrobial recommendations, not contraindicated due to allergy history or availability. Treatment of patients with antibiotic allergies is complex, and a frequent issue encountered. To determine if premenopausal women 18 to 50 years of age with uncomplicated cystitis and an allergy to a guideline-recommended antimicrobial agent are less likely to receive guideline-recommended treatment compared to women without an allergy. The study was approved by Spartanburg Regional Healthcare System (SRHS) Institutional Review Board (1711429-1). An electronic medical record was used to identify female patients between ages 18-50 with acute uncomplicated cystitis at outpatient visits between December 1, 2017 through December 31, 2021 within SRHS Family Medicine Residency Clinic using ICD-10 codes N30.0 (acute cystitis without hematuria), N39.0 (urinary tract infections), and R30.0 (dysuria). Patients with complicated urinary tract infections or pyelonephritis were excluded. After identification of eligible subjects, a retrospective chart review was used to collect demographic information, known antimicrobial allergies, urinalysis and culture information, and prescribed antimicrobial agent. The primary outcome was receipt of a guideline-recommended antimicrobial. Secondary outcomes included prevalence of antimicrobial allergies, and a priori defined subgroup analyses of patients with allergies to preferred agents. The data was analyzed by a biostatistician using the individual as the unit of observation. Nominal data was analyzed using Chi-Squared or Fisher’s Exact tests. Continuous data was analyzed using t-test, analysis of variance, or Wilcoxon rank-sum tests. This study sought to evaluate prescribing practices for premenopausal women in treatment of UTI. 496 patient encounters were screened, with 183 meeting inclusion criteria. Antimicrobial allergies were noted in 40 patients, most frequently to beta-lactams (60%), followed by TMP-SMX (22%), nitrofurantoin (12%), and fluoroquinolones (5%). Demographic and clinical characteristics were similar between patients with and without antimicrobial allergies, except for age. Patients without an antimicrobial allergy were significantly more likely to receive a guideline-recommended therapy (140 of 143 patients; 98%) compared to those with an allergy (33 of 40 patients; 82%) to a guideline recommended antimicrobial agent (p=0.001). No difference in secondary outcomes was observed. Patients with antimicrobial allergy were less likely to receive a guideline-recommended antimicrobial for acute uncomplicated cystitis. No statistical difference was seen in secondary outcome analyses, likely due to small sample size for these subgroup analyses. Study limitations include retrospective documentation data use, strict inclusion/exclusion criteria potentially limiting external validity of data, and inability to capture outside factors that influenced prescribing other than antimicrobial allergy. Future implications include development of a quality improvement project to assess impact of an educational initiative on prescribing in this population.

*VCOM Student