Presentation Authors: Elisabeth M. Sebesta*, Anika March, Christopher Sayegh, Gen Li, Michelle Love, Gina M. Badalato, Marcy Ferdschneider, Kimberly L. Cooper, New York, NY
Introduction: Recommendations for management of women with suspected uncomplicated lower urinary tract infections (UTIs) include presumptive antibiotics (abx), with or without obtaining a urine culture (UCx). However, with increasing abx resistance, efforts to decrease abx usage are vital. We instituted this study at Columbia University Medical Center Student Health Services (CUMC-SHS) to determine if presumptive treatment of women with suspected uncomplicated UTIs is contributing to unnecessary abx usage.
Methods: We retrospectively reviewed all non-pregnant female patients presenting to CUMC-SHS with UTI symptoms from 12/2016-5/2017 who had UCx sent. Clinical information and presenting symptoms, in addition to office urine dip (Udip) and UCx results, were reviewed. Patients with upper urinary tract involvement or already on abx were excluded. Chi-squared and Fischerâ€™s exact tests were performed to compare patients with a positive and negative UCx.
Results: A total of 67 patients were included for analysis. Presenting symptoms included dysuria (59/60, 98%), frequency (41/45, 91%), urgency (27/27, 100%), gross hematuria (17/33, 51%), and suprapubic pain (20/53, 38%). Many patients had symptoms for less than or equal to 24 hours before presentation (32/64, 50%). Office Udip was performed on 33/67 (49%) patients, the results of which were negative in 9%. Dips were positive for leukocytes (88%), blood (79%), and nitrites (18%). All patients were prescribed abx, most commonly nitrofurantoin (82%). Culture results were negative in 29/67 (43%). The most common pathogen on positive UCx was E. coli (84%). There were no significant differences in duration of symptoms, presenting symptoms, or Udip results between patients with a negative UCx and those with a positive UCx.
Conclusions: Although current recommendations state standard of care for women with suspected uncomplicated UTI is presumptive abx, our study at a health sciences campus found a significant negative UCx rate, representing a cohort of patients who were exposed to abx unnecessarily. Additionally, we found no difference in presenting symptoms or Udip results to help distinguish patients with a positive UCx. It is now current practice at CUMC-SHS to recommend urinary analgesics and to wait for UCx results prior to initiating abx. We believe the findings of this study suggest a cohort in which abx usage can be reduced.