VCOM Research Day Program Book 2023

Medical Student Research Cl inical

03 The Prevalence of Urinary Tract Infections and Antibiotic Prescription Treatments Across 3 Countries; a Retrospective Study Using Credo

The Clinical Rotation Evaluation and Documentation Organizer (CREDO) is an electronic medical record (EMR) system designed to track patient data and mirror EMRs that medical students would utilize in practice. All health care providers who partner with VCOM can gain access to CREDO and input their patient data, as well. This is useful in underdeveloped countries that do not have the infrastructure to integrate their own EMR and, therefore, still use paper-based medical records. Additionally, these data can be used to identify trends in disease outbreak, prescription use, data discrepancies, etc. across clinics and countries. Using CREDO, a random sample of patient data was analyzed, retrospectively, to determine the prevalence of urinary tract infection (UTI) diagnosis with corresponding prescription recommendation over a twelve-month period between three Latin American countries (i.e., Dominican Republic, El Salvador, and Honduras). It was hypothesized that disease diagnosis with prescription recommendation would be constant from May 2021 to May 2022. The data was imported into Excel and was filtered using codes specific to UTIs: N39.0 (UTI, site not specified) and O86.20 (UTI following delivery, Rachael Lee 1 ; Nathan Hass 2 ; Allie Kollitz 2 ; Meghan Wilson 1 Corresponding author: Rlee02@vcom.edu 1 Edward Via College of Osteopathic Medicine-Virginia Campus 2 Virginia Polytechnic Institute and State University, Blacksburg

unspecified). The prescription data was then extracted for each reported UTI, antibiotics were identified, and codes were filtered to further determine which antibiotics were prescribed most frequently. For each month, the total number of UTI codes and prescription codes were summed and graphed to compare across and within the three countries. In El Salvador, there were 142 UTIs and 126 prescriptions written for UTIs in twelve months. Of the 20 different antibiotics prescribed, Ciprofloxacin was prescribed most frequently at a rate of 43.7%. The highest and lowest months with reported UTIs were April 2022 (n=33) and May 2022 (n=6), respectively. There were no reported UTI diagnoses in May 2021 through September 2021. In Honduras, there were 68 UTIs and 68 prescriptions written for the UTIs reported in twelve months. Of the 17 different antibiotics prescribed, Ciprofloxacin was prescribed most frequently at a rate of 39.7%. The months with the highest reported UTI diagnoses were June 2021 and May 2022 (n=12) compared to the lowest reported number of UTI diagnoses in November 2021 (n=2). There were no reported UTI diagnoses in December 2021 through February 2022. In the Dominican

Republic, there were 42 UTIs and 14 prescriptions written for those UTIs reported in twelve months. Of the 3 different antibiotics prescribed, Fosfomycin was prescribed most frequently at a rate of 61.5% of all UTIs reported. The only two months with reported UTIs in the Dominican Republic were April 2022 (n=30) and May 2022 (n=12). The findings above did not support the original hypothesis. These data, across countries, suggest that there are inconsistent UTI reports throughout the year with a variety of antibiotics prescribed for UTIs. The variability in number of UTI reports was seen within each country and across each country. However, there is consistency in the type of antibiotics prescribed for reported UTIs in El Salvador and Honduras but not in the Dominican Republic. The discovered discrepancies in disease reporting and prescription recommendation suggests inconsistent reporting in CREDO. In the future, focused education or revision on CREDO reporting and uniform coding practices could be implemented to reduce these inconsistencies.

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