Document Detail


Urinary tract infection in male veterans: treatment patterns and outcomes.
MedLine Citation:
PMID:  23212273     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Lengthier antimicrobial therapy is associated with increased costs, antimicrobial resistance, and adverse drug events. Therefore, establishing minimum effective antimicrobial treatment durations is an important public health goal. The optimal treatment duration and current treatment patterns for urinary tract infection (UTI) in men are unknown. We used Veterans Affairs administrative data to study male UTI treatment and outcomes.
METHODS: Male UTI episodes in the Veterans Affairs system (fiscal year 2009) were identified by combining International Classification of Diseases, Ninth Revision codes with UTI-relevant antimicrobial prescriptions. Episodes were categorized as index, early recurrence (<30 days), or late recurrence (≥30 days) cases. Drug name, treatment duration, and outcomes (recurrence and Clostridium difficile infection during 12 months) were recorded for index cases. Demographic, clinical, and treatment characteristics were assessed for associations with outcomes in univariate and multivariate analyses.
RESULTS: Among 4 854 765 outpatient male veterans, 39 149 UTI episodes involving 33 336 unique patients were identified, including 33 336 index cases (85.2%), 1772 early recurrences (4.5%), and 4041 late recurrences (10.3%). Highest-use antimicrobial agents were ciprofloxacin (62.7%) and trimethoprim-sulfamethoxazole (26.8%); 35.0% of patients received shorter-duration treatment (≤7 days), and 65.0% of patients received longer-duration treatment (>7 days). Of the index cases, 4.1% were followed by early recurrence and 9.9% by late recurrence. Longer-duration treatment was not associated with a reduction in early or late recurrence but was associated with increased late recurrence compared with shorter-duration treatment (10.8% vs 8.4%, P < .001), including in multivariate analysis (odds ratio, 1.20; 95% CI, 1.10-1.30). In addition, C difficile infection risk was significantly higher with longer-duration vs shorter-duration treatment (0.5% vs 0.3%, P = .02) and exhibited a similar suggestive trend in multivariate analysis (odds ratio, 1.42; 95% CI, 0.97-2.07).
CONCLUSION: Longer-duration treatment (>7 days) for male UTI in the outpatient setting was associated with no reduction in early or late recurrence.
Authors:
Dimitri M Drekonja; Thomas S Rector; Andrea Cutting; James R Johnson
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  JAMA internal medicine     Volume:  173     ISSN:  2168-6114     ISO Abbreviation:  JAMA Intern Med     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-02-20     Completed Date:  2013-03-14     Revised Date:  2013-10-24    
Medline Journal Info:
Nlm Unique ID:  101589534     Medline TA:  JAMA Intern Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  62-8     Citation Subset:  AIM; IM    
Affiliation:
Minneapolis Veterans Affairs Health Care System, Minneapolis, MN 55417, USA. drek0002@umn.edu
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MeSH Terms
Descriptor/Qualifier:
Aged
Anti-Infective Agents* / administration & dosage,  adverse effects
Ciprofloxacin / administration & dosage,  adverse effects
Clostridium Infections* / drug therapy,  epidemiology
Comorbidity
Drug Administration Schedule
Drug Resistance, Microbial
Episode of Care
Humans
Male
Medication Therapy Management* / standards,  statistics & numerical data
Outcome Assessment (Health Care)
Recurrence / prevention & control
Time Factors
Treatment Outcome
Trimethoprim-Sulfamethoxazole Combination / administration & dosage,  adverse effects
United States / epidemiology
United States Department of Veterans Affairs / statistics & numerical data
Urinary Tract Infections* / drug therapy,  epidemiology
Veterans
Chemical
Reg. No./Substance:
0/Anti-Infective Agents; 8064-90-2/Trimethoprim-Sulfamethoxazole Combination; 85721-33-1/Ciprofloxacin
Comments/Corrections
Comment In:
J Urol. 2013 Oct;190(4):1253-4   [PMID:  24029324 ]
JAMA Intern Med. 2013 Jun 24;173(12):1154   [PMID:  23797165 ]
JAMA Intern Med. 2013 Jan 14;173(1):68-70   [PMID:  23212451 ]
JAMA Intern Med. 2013 Jan 14;173(1):71-2   [PMID:  23212291 ]
JAMA Intern Med. 2013 Jun 24;173(12):1153-4   [PMID:  23797164 ]

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