Authors Liz Lively, Amanda Stankowitz, Alexander Tunnell, Mallorie Vaughn
Background A multitude of organizations have released guidelines to aid providers in the treatment of urinary tract infections in women based on pregnancy status. The Clinical Practice Guidelines for the Treatment of Acute Uncomplicated Cystitis and Pyelonephritis in Women: 2010 Update by the IDSA provide specific recommendations for drug therapy and treatment options for non-pregnant women. According to the 2019 IDSA guidelines for asymptomatic bacteriuria (ASB), antibiotics should not be prescribed to treat women who have ASB but are not pregnant. Conversely, according to the 2023 ACOG Clinical Consensus for urinary tract infection, pregnant women with bacteria in the urine should be prescribed antibiotics, regardless of symptoms. The goal of this study was to assess the current state of antibiotic prescribing practices for female patients diagnosed with ASB or uncomplicated cystitis at two outpatient primary care offices, WT Anderson Community Health Center (WTACHC) and Primary Care West Macon (PCWM). Methods Researchers utilized a database generated report to conduct a chart review of all women who had a primary diagnosis of ASB, UTI, or cystitis as documented by ICD-10 code. Females ages 18 and older were included if they were seen at WTACHC or PCWM from January 1, 2024 to December 31, 2024. The primary outcome of this study was the percent of women seen at WTACHC or PCWM who were diagnosed with ASB and treated appropriately per IDSA or ACOG guidelines. Secondary outcomes evaluated the percent of women who were diagnosed with ASB and treated appropriately based on pregnancy status and location. Additional secondary outcomes included the incidence of misdiagnosis of uncomplicated cystitis without documented symptoms of a UTI and a descriptive analysis of the antibiotics prescribed, duration of therapy, and whether they align with recommended practices for empiric treatment of ASB or uncomplicated cystitis per IDSA or ACOG guidelines. Results Of the 93 subjects included in the study, six were from WTACHC and 87 from PCWM. Regarding the primary outcome, 28.6% (4/14) of adult women seen at WTACHC or PCWM met criteria for ASB and were treated appropriately. For secondary outcomes, overall, 33.3% (4/12) of non-pregnant women and none (0/2) of the pregnant women who were diagnosed with ASB were treated appropriately. There were no patients seen at WTACHC diagnosed with ASB, all six at this location had uncomplicated cystitis. Therefore, it was not possible to assess this secondary outcome at WTACHC. At PCWM, 28.6% (4/14) met criteria for ASB and were treated appropriately. Of all patients diagnosed with uncomplicated cystitis, 22.9% (19/83) were misdiagnosed due to lack of documented UTI symptoms. A total of 83 patients were prescribed antibiotics, most commonly with nitrofurantoin at 62.7% (52/83) or SMX/TMP at 16.9% (14/83). Of the patients who were prescribed antibiotics, 90.4% (75/83) were prescribed an appropriate antibiotic per the IDSA or ACOG guidelines. However, only 55.4% (46/83) were treated with the appropriate duration, which varies from 5-10 days based on agent and pregnancy status. The overall average duration of prescribed therapy was 6.29 days. Among the entire sample, 44.1% (41/93) of patients were treated appropriately for uncomplicated cystitis or ASB. Conclusion A majority of patients seen at WTACHC and PCWM diagnosed with ASB in 2024 were not treated per guidelines. Most of the patients diagnosed with uncomplicated cystitis were prescribed an appropriate antibiotic, but many had treatment durations beyond IDSA and ACOG guidance. Lack of documentation of symptoms may have falsely elevated the number of patients with ASB. Additionally, a significant limitation was identified in using ICD-10 coding to identify ASB, which limited the study population. Future initiatives should instead utilize urine culture to fully capture patients with ASB.
