探索男性复杂性尿路感染推荐首选疗法的差异:从不同年龄、种族和民族的门诊环境中获得的启示。

IF 2.9 3区 医学 Q2 PHARMACOLOGY & PHARMACY Pharmacotherapy Pub Date : 2024-04-01 Epub Date: 2024-03-14 DOI:10.1002/phar.2912
Kathryn Sine, Thomas Lavoie, Aisling R Caffrey, Vrishali V Lopes, David Dosa, Kerry L LaPlante, Haley J Appaneal
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引用次数: 0

摘要

导言:众所周知,传染病的治疗存在差异。然而,复杂性尿路感染(UTI)治疗中的差异在很大程度上尚未得到调查:我们按年龄、种族和民族划分了退伍军人事务局(VA)门诊中男性尿路感染治疗的特点,并确定了可预测推荐首选抗生素治疗的人口统计学特征:我们对 2010 年 1 月至 2020 年 12 月期间被诊断为尿毒症并在门诊接受抗生素治疗的退伍军人事务部男性患者进行了一项全国性回顾性队列研究。复杂性UTI的推荐首选疗法被定义为使用推荐的一线抗生素药物(环丙沙星、左氧氟沙星或磺胺甲恶唑/三甲氧苄啶),且推荐疗程为7至10天。多变量模型用于确定推荐首选疗法的人口统计学预测因素(调整后的几率比 [aOR] > 1):结果:我们发现共有 157898 名男性在门诊接受了UTI 诊断和治疗。平均抗生素使用时间为 9.4 天(± 标准差 [SD] 4.6),47.6% 的患者使用环丙沙星,25.1% 使用磺胺甲噁唑/三甲双胍,7.6% 使用硝基呋喃妥因,6.6% 使用左氧氟沙星。只有一半的男性患者(50.6%,n=79,928)接受了推荐的首选治疗(一线药物选择和适当的疗程);77.6%(n=122,590)的患者接受了推荐的抗生素选择治疗,65.9%(n=104,070)的患者接受了推荐的疗程治疗。年龄 18-49 岁(aOR 1.07,95% 置信区间 [CI] 1.03-1.11)与年龄≥65 岁是预测推荐首选疗法的唯一人口统计学因素:结论:本研究中近半数患者未接受推荐的首选疗法,但未发现种族和民族差异。复杂性UTI未充分利用推荐的首选抗生素治疗仍是抗菌药物管理项目的重点领域。
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Exploring variations in recommended first-choice therapy for complicated urinary tract infections in males: Insights from outpatient settings across age, race, and ethnicity.

Introduction: There are known disparities in the treatment of infectious diseases. However, disparities in treatment of complicated urinary tract infections (UTIs) are largely uninvestigated.

Objectives: We characterized UTI treatment among males in Veterans Affairs (VA) outpatient settings by age, race, and ethnicity and identified demographic characteristics predictive of recommended first-choice antibiotic therapy.

Methods: We conducted a national, retrospective cohort study of male VA patients diagnosed with a UTI and dispensed an outpatient antibiotic from January 2010 through December 2020. Recommended first-choice therapy for complicated UTI was defined as use of a recommended first-line antibiotic drug choice regardless of area of involvement (ciprofloxacin, levofloxacin, or sulfamethoxazole/trimethoprim) and a recommended duration of 7 to 10 days of therapy. Multivariable models were used to identify demographic predictors of recommended first-choice therapy (adjusted odds ratio [aOR] > 1).

Results: We identified a total of 157,898 males diagnosed and treated for a UTI in the outpatient setting. The average antibiotic duration was 9.4 days (±standard deviation [SD] 4.6), and 47.6% of patients were treated with ciprofloxacin, 25.1% with sulfamethoxazole/trimethoprim, 7.6% with nitrofurantoin, and 6.6% with levofloxacin. Only half of the male patients (50.6%, n = 79,928) were treated with recommended first-choice therapy (first-line drug choice and appropriate duration); 77.6% (n = 122,590) were treated with a recommended antibiotic choice and 65.9% (n = 104,070) with a recommended duration. Age 18-49 years (aOR 1.07, 95% confidence interval [CI] 1.03-1.11) versus age ≥65 years was the only demographic factor predictive of recommended first-choice therapy.

Conclusions: Nearly half of the patients included in this study did not receive recommended first-choice therapies; however, racial and ethnic disparities were not identified. Underutilization of recommended first-choice antibiotic therapy in complicated UTIs continues to be an area of focus for antimicrobial stewardship programs.

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来源期刊
Pharmacotherapy
Pharmacotherapy 医学-药学
CiteScore
7.80
自引率
2.40%
发文量
93
审稿时长
4-8 weeks
期刊介绍: Pharmacotherapy is devoted to publication of original research articles on all aspects of human pharmacology and review articles on drugs and drug therapy. The Editors and Editorial Board invite original research reports on pharmacokinetic, bioavailability, and drug interaction studies, clinical trials, investigations of specific pharmacological properties of drugs, and related topics.
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