When Empiric Therapy Fails: Clinical and Economic Consequences in uUTIs Among US Women
TL;DR
Patients with TF had significantly higher risk of adverse outcomes and greater HCRU than patients without TF, and patients with TF had significantly greater all-cause and UTI-related HCRU.
Abstract
Uncomplicated urinary tract infection (uUTI) management is increasingly challenging due to antibiotic treatment failure (TF). This retrospective, observational cohort study used Optum’s de-identified Electronic Health Record dataset (January 2017–September 2022) to investigate the impact of antibiotic TF (defined as a second oral antibiotic prescription, administration of an intravenous antibiotic, or an emergency department visit/hospitalization with a new primary diagnosis of urinary tract infection <28 days post index) on clinical outcomes and healthcare resource utilization (HCRU) among women with uUTI. Eligible patients were female, aged ≥12 years, with an outpatient diagnosis of uUTI and one or more empirically prescribed oral antibiotics within ±5 days of diagnosis (index). Adjusted risk ratios (aRR) of adverse clinical outcomes were assessed ≤12 months post index (observation period), and rate ratios of all-cause and UTI-related HCRU during the index episode and observation period were observed. Of 376,004 patients, 62,873 (16.7%) experienced TF, while 313,131 (83.3%) did not. Patients with TF had significantly higher risk (aRR [95% CI]) of recurrent UTI (1.23 [1.21, 1.25]) and acute pyelonephritis (1.77 [1.70, 1.84]) (both p < 0.001) versus those without. Patients with TF had significantly greater all-cause and UTI-related HCRU versus patients without. Overall, patients with TF had significantly higher risk of adverse outcomes and greater HCRU than patients without TF.