Prescribing Without Guidance: Antibiotic Prescribing for Male Urinary Tract Infection (UTI) in Primary Care

IDWEEK 2015 POSTER ABSTRACTS 159. Prescribing Without Guidance: Antibiotic Prescribing for Male Urinary Tract Infection (UTI) in Primary Care Haley K. Holmer, MPH1; Miriam R. Elman, MPH2; Charlesnika Evans, PhD, MPH3; Katie J. Suda, PharmD4; Jessina C. Mcgregor, PhD5; 1Public Health and Preventive Medicine, Oregon Health and Science University, School of Medicine, Portland, Oregon; 2Department of Pharmacy Practice, Oregon State University/Oregon Health and Science University College of Pharmacy, Portland, Oregon; 3Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, Hines, Ilinois; 4Center for Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, Hines, Ilinois; 5Department Pharmacy Practice, Oregon State University College of Pharmacy, Portland, Oregon and Department Public Health and Preventive Medicine, Oregon Health and Science University School of Medicine, Portland, Oregon Session: 42. Antimicrobial Stewardship: Current State and Future Opportunities Thursday, October 8, 2015: 12:30 PM Background. Little evidence exists regarding the best antibiotic regimen for UTI in men. Our objective was to describe current practice patterns in the treatment of male UTI in primary care clinics and evaluate the concordance between antibiotic prescribing and antibiotic susceptibility of uropathogens in men with acute UTI. Methods. We conducted a cross-sectional study of adult male outpatients with an acute UTI diagnosis occurring at primary care visits at Oregon Health and Science University between 2010 and 2014. Patient characteristics, encounter information, pharmacy orders, and laboratory data were extracted from electronic medical records. We summarized frequency of antibiotics prescribed ±3 days of the visit. By stratifying these by pathogen susceptibilities, we quantified the occurrence of discordant treatment and broad-spectrum antibiotic use. Results. A total of 592 visits, representing 372 males were included. Unspecified UTI was diagnosed in 90.9% of visits, followed by acute pyelonephritis and cystitis (4.7% each). Common comorbidities included diabetes (25.3%) followed by kidney disease (23.1%) and paraplegia or quadriplegia (5.6%). Of the 374 (63.2%) encounters in which an antibiotic was prescribed, 59.1% received a fluoroquinolone (FQ), and 24.3% received trimethoprim-sulfamethoxazole (TMP/SMX). Cultures were performed in 262 (44.3%) of visits, 157 (59.9%) of which were positive. Escherichia coli was the most frequently isolated uropathogen (41.4%), followed by Enterococcus (19.4%) and Klebsiella (7.8%). In patients prescribed a FQ, 10.3% had a FQ-resistant isolate whereas among those prescribed TMP/SMX, 35.5% had a TMP/SMX-resistant isolate. In patients with isolates susceptible to both TMP/SMX and FQ, only 15.0% (12/80) were treated with TMP/SMX whereas 76.3% (61 of 80) received a FQ. Conclusion. Discordance exists between pathogen susceptibility and prudent antibiotic prescribing for male UTI in the outpatient setting. The majority of isolates in our study were susceptible to TMP/SMX but few patients received TMP/SMX relative to broader spectrum agents. Clinical guidance is needed to prevent excess prescribing of FQ and other broad-spectrum agents. Disclosures. All authors: No reported disclosures. Open Forum Infectious Diseases 2015;2:71–536 © The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/ by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact . DOI: 10.1093/ofid/ofv133 Poster Abstracts • OFID 2015:2 (Suppl 1) • S71  (...truncated)