Open Access

ARTICLE

Assessment of practices in screening and treating women with bacteriuria

Erica L. Ditkoff¹, Marissa Theofanides², Carrie Mlynarczyk Aisen², Casey G. Kowalik³, Joshua A. Cohn³, Wilson Sui³, Matthew Rutman², Rony A. Adam⁴, Roger R. Dmochowski³, Kimberly L. Cooper²

1 Divison of Urological Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
2 Department of Urology, Columbia University College of Physicians and Surgeons, New York, New York, USA
3 Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
4 Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
Address correspondence to Dr. Marissa Theofanides, 161 Ft Washington Ave, 11th Floor, New York, NY 10032 USA

Canadian Journal of Urology 2018, 25(5), 9486-9496.

Abstract

Introduction: Evidence-based screening and treatment for bacteriuria is crucial to prevent increasing antibiotic resistance. The Infectious Disease Society of America (IDSA) previously released guidelines on the management of asymptomatic bacteriuria (ASB) and uncomplicated urinary tract infections (UTIs) in women. The study’s objective was to assess physicians’ practices in managing women with bacteriuria relative to these guideline recommendations.
Materials and methods: Cross-sectional data from physicians were collected using an anonymous questionnaire. Multivariable logistic regression analyses identified independent predictors of adherence to guidelines.
Results: Data were collected from 260 physicians. Over half of physicians surveyed were unfamiliar with IDSA guidelines and overtreat ASB. Variables independently associated with overtreatment of ASB included a non-academic practice and practicing as an OBGYN. Nearly one third (30.1%) of physicians reported prescribing an antibiotic other than a recommended first-line agent for uncomplicated cystitis. Relative to internists, OBGYNs and urologists were more likely to prescribe a recommended first-line agent to women with uncomplicated cystitis. Of those who correctly selected a first-line agent, 29.8% prescribed a longer than recommended duration of therapy. IDSA guideline awareness was not associated with physicians’ practices in managing women with bacteriuria.
Conclusions: Most physicians surveyed were unfamiliar with guidelines related to managing ASB and uncomplicated UTIs in women, likely contributing to overscreening and overtreatment of ASB and the use of inappropriate antibiotic regimens in treating uncomplicated cystitis. However, optimal antibiotic prescribing was not associated with knowledge of IDSA guidelines, suggesting that guideline dissemination alone may not alter practice patterns among physicians managing women with bacteriuria.

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