Julia Shinnick, Isabel Josephs, Johanna A Suskin, Kathryn Kurchena, Lindsey Pileika, Spencer Darveau, Matthew M Scarpaci, Cassandra Carberry
{"title":"复发性尿毒症患者的抗生素疗程与尿毒症疗效","authors":"Julia Shinnick, Isabel Josephs, Johanna A Suskin, Kathryn Kurchena, Lindsey Pileika, Spencer Darveau, Matthew M Scarpaci, Cassandra Carberry","doi":"10.1097/SPV.0000000000001497","DOIUrl":null,"url":null,"abstract":"<p><strong>Importance: </strong>Little evidence is available to inform management of acute urinary tract infections (UTIs) in women with recurrent urinary tract infection (rUTI).</p><p><strong>Objective: </strong>This study aimed to compare the proportion of acute UTIs with persistence/relapse or recurrence based on duration of treatment antibiotics (acute UTI guideline-consistent versus extended).</p><p><strong>Study design: </strong>A retrospective noninferiority study of women with rUTI was performed at an academic tertiary referral center from January 2016 to December 2020. Exposure was UTI treatment with acute UTI guideline-consistent versus extended antibiotics. Outcomes were persistent/relapsed UTI (subsequent culture with the same pathogen requiring additional antibiotics within 4 weeks), recurrent UTI (culture with different pathogen), or resolution. Sample size was calculated under the null hypothesis that the proportion of acute UTIs with persistence/relapse or recurrence after acute UTI guideline-consistent antibiotics would be within a 10% noninferiority margin of extended duration (α = 0.05, β = 0.20, 2-sided tests, P < 0.05 significant).</p><p><strong>Results: </strong>We included 219 patients with 553 acute UTIs. The mean ± SD number of UTIs per patient was 2.53 ± 1.88, the mean ± SD age was 68.60 ± 16.29 years, and the mean ± SD body mass index was 29.73 ± 7 (calculated as weight in kilograms divided by height in meters squared). There were no differences in prior surgical procedures postvoid residual volume, pelvic floor disorders, or preventive treatments between groups. Two-hundred sixty UTIs (260 of 553 [47%]) were treated with acute UTI guideline-consistent antibiotics. Overall, 86 of 553 UTIs (15.6%) persisted/relapsed, and 29 of 553 (5.2%) recurred. The difference in the proportions of UTIs with persistence/relapse or recurrence excluded the noninferiority margin (4.4%; 95% confidence interval, -0.04 to 6.80%). In total, 115 of 553 UTIs (20.8%) had persistence/relapse or recurrence.</p><p><strong>Conclusion: </strong>In this cohort of patients with rUTI experiencing acute UTIs, acute UTI guideline-consistent duration of antibiotics was noninferior.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":null,"pages":null},"PeriodicalIF":0.8000,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Antibiotic Duration and UTI Outcomes in Recurrent UTI Patients.\",\"authors\":\"Julia Shinnick, Isabel Josephs, Johanna A Suskin, Kathryn Kurchena, Lindsey Pileika, Spencer Darveau, Matthew M Scarpaci, Cassandra Carberry\",\"doi\":\"10.1097/SPV.0000000000001497\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Importance: </strong>Little evidence is available to inform management of acute urinary tract infections (UTIs) in women with recurrent urinary tract infection (rUTI).</p><p><strong>Objective: </strong>This study aimed to compare the proportion of acute UTIs with persistence/relapse or recurrence based on duration of treatment antibiotics (acute UTI guideline-consistent versus extended).</p><p><strong>Study design: </strong>A retrospective noninferiority study of women with rUTI was performed at an academic tertiary referral center from January 2016 to December 2020. Exposure was UTI treatment with acute UTI guideline-consistent versus extended antibiotics. Outcomes were persistent/relapsed UTI (subsequent culture with the same pathogen requiring additional antibiotics within 4 weeks), recurrent UTI (culture with different pathogen), or resolution. Sample size was calculated under the null hypothesis that the proportion of acute UTIs with persistence/relapse or recurrence after acute UTI guideline-consistent antibiotics would be within a 10% noninferiority margin of extended duration (α = 0.05, β = 0.20, 2-sided tests, P < 0.05 significant).</p><p><strong>Results: </strong>We included 219 patients with 553 acute UTIs. The mean ± SD number of UTIs per patient was 2.53 ± 1.88, the mean ± SD age was 68.60 ± 16.29 years, and the mean ± SD body mass index was 29.73 ± 7 (calculated as weight in kilograms divided by height in meters squared). There were no differences in prior surgical procedures postvoid residual volume, pelvic floor disorders, or preventive treatments between groups. Two-hundred sixty UTIs (260 of 553 [47%]) were treated with acute UTI guideline-consistent antibiotics. Overall, 86 of 553 UTIs (15.6%) persisted/relapsed, and 29 of 553 (5.2%) recurred. The difference in the proportions of UTIs with persistence/relapse or recurrence excluded the noninferiority margin (4.4%; 95% confidence interval, -0.04 to 6.80%). In total, 115 of 553 UTIs (20.8%) had persistence/relapse or recurrence.</p><p><strong>Conclusion: </strong>In this cohort of patients with rUTI experiencing acute UTIs, acute UTI guideline-consistent duration of antibiotics was noninferior.</p>\",\"PeriodicalId\":75288,\"journal\":{\"name\":\"Urogynecology (Hagerstown, Md.)\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.8000,\"publicationDate\":\"2024-03-27\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Urogynecology (Hagerstown, Md.)\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1097/SPV.0000000000001497\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"OBSTETRICS & GYNECOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Urogynecology (Hagerstown, Md.)","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1097/SPV.0000000000001497","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"OBSTETRICS & GYNECOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
重要性：目前几乎没有证据可以为管理复发性尿路感染（rUTI）妇女的急性尿路感染（UTI）提供参考：本研究旨在比较急性UTI持续/复发或复发的比例，其依据是抗生素治疗的持续时间（急性UTI指南一致与延长）：研究设计：2016 年 1 月至 2020 年 12 月，在一家学术性三级转诊中心对患有 rUTI 的女性进行了一项回顾性非劣效性研究。研究对象为使用急性 UTI 指南一致抗生素与延长抗生素治疗 UTI 的患者。结果为UTI持续/复发（后续培养出相同病原体，需要在4周内追加抗生素）、UTI复发（培养出不同病原体）或缓解。样本量是在以下零假设下计算的：急性UTI指南一致抗生素治疗后，急性UTI持续/复发或复发的比例将在延长疗程的10%非劣效差范围内（α=0.05，β=0.20，双侧检验，P<0.05显著）：我们纳入了 219 名患者，共 553 例急性 UTI。每位患者的平均（±SD）尿毒症次数为 2.53 ± 1.88，平均（±SD）年龄为 68.60 ± 16.29 岁，平均（±SD）体重指数为 29.73 ± 7（以体重（公斤）除以身高（米）平方计算）。各组之间在手术后残余尿量、盆底障碍或预防性治疗方面没有差异。260 例 UTI（553 例中的 260 例 [47%]）接受了急性 UTI 指南一致的抗生素治疗。总体而言，553 例 UTI 中有 86 例（15.6%）持续/复发，553 例中有 29 例（5.2%）复发。UTI持续/复发或复发比例的差异排除了非劣效边际（4.4%；95% 置信区间，-0.04 至 6.80%）。在553例UTI中，共有115例（20.8%）出现持续/复发或复发：结论：在这批急性 UTI 患者中，急性 UTI 指南一致的抗生素疗程并无劣效。
Antibiotic Duration and UTI Outcomes in Recurrent UTI Patients.
Importance: Little evidence is available to inform management of acute urinary tract infections (UTIs) in women with recurrent urinary tract infection (rUTI).
Objective: This study aimed to compare the proportion of acute UTIs with persistence/relapse or recurrence based on duration of treatment antibiotics (acute UTI guideline-consistent versus extended).
Study design: A retrospective noninferiority study of women with rUTI was performed at an academic tertiary referral center from January 2016 to December 2020. Exposure was UTI treatment with acute UTI guideline-consistent versus extended antibiotics. Outcomes were persistent/relapsed UTI (subsequent culture with the same pathogen requiring additional antibiotics within 4 weeks), recurrent UTI (culture with different pathogen), or resolution. Sample size was calculated under the null hypothesis that the proportion of acute UTIs with persistence/relapse or recurrence after acute UTI guideline-consistent antibiotics would be within a 10% noninferiority margin of extended duration (α = 0.05, β = 0.20, 2-sided tests, P < 0.05 significant).
Results: We included 219 patients with 553 acute UTIs. The mean ± SD number of UTIs per patient was 2.53 ± 1.88, the mean ± SD age was 68.60 ± 16.29 years, and the mean ± SD body mass index was 29.73 ± 7 (calculated as weight in kilograms divided by height in meters squared). There were no differences in prior surgical procedures postvoid residual volume, pelvic floor disorders, or preventive treatments between groups. Two-hundred sixty UTIs (260 of 553 [47%]) were treated with acute UTI guideline-consistent antibiotics. Overall, 86 of 553 UTIs (15.6%) persisted/relapsed, and 29 of 553 (5.2%) recurred. The difference in the proportions of UTIs with persistence/relapse or recurrence excluded the noninferiority margin (4.4%; 95% confidence interval, -0.04 to 6.80%). In total, 115 of 553 UTIs (20.8%) had persistence/relapse or recurrence.
Conclusion: In this cohort of patients with rUTI experiencing acute UTIs, acute UTI guideline-consistent duration of antibiotics was noninferior.
京公网安备 11010802042870号
京ICP备2023020795号-1
分享
求助内容：
应助结果提醒方式：
扫码关注我们
