(Poster 169) Rates of Care-seeking After Empiric Treatment for Urinary Tract Infection

Objectives: Evaluate the rate of any subsequent ED visits, ED visits with a urinary chief complaint, changes to empiric antibiotic treatment, and urinalysis or urine cultures in the 3 months following empiric outpatient treatment of a UTI.

Methods: This was a retrospective cohort of women 18 years or older who were treated outpatient for an acute uncomplicated UTI at one of 13 ED sites within a single tertiary medical center between October 2023 and April 2024. All patients had a reflex urine culture sent and received an empiric antibiotic prescription at the time of index ED visit. Two subcohorts were defined for comparison: resultant positive urine culture at index visit versus negative culture (over-treatment). Baseline cohort characteristics including age, ED location, chief complaint, comorbidities, antibiotic allergy history, ED urinalysis and history of prior urine studies over the last 12 months were defined. Over the 3-month follow-up period, any subsequent ED visits, urinary chief complaint at ED visit, new allergies recorded, urologic procedures, contact by pharmacy regarding culture results and any subsequent changes to empiric antibiotic treatment, and urinalysis or urine cultures performed in any setting were collected. Descriptive statistics were performed using t-test, chi-squared test between the subcohorts above.

Results: We identified 3,714 individual women with index ED visits over the 6-month period. In total, 1,417 (38.2%) had at least one subsequent ED visit for any reason including 372 (10.0%) for a urinary chief complaint in the 3-month follow-up period.

A positive urine culture resulted in 1,181 (31.8%) of index visits. At least one subsequent ED visit occurred in 39.7 % of women with a positive culture and 37.4% in cases of negative cultures (p = 0.194).

At least one subsequent ED visit for a urinary chief complaint occurred in 10.4% of cases with a positive culture compared to 9.8% with a negative culture (p = 0.621).

Additional urine testing including urinalysis (p = 0.030) and urine culture (p = 0.002) occurred more frequently in those with a positive index culture. A subsequent positive urine culture resulted during the 3 months in 14.3% of women with an index positive urine culture compared to 7.1% with a negative index culture (p < 0.001).

There were no differences in urologic procedures or new allergies listed over the 3 months.

Conclusions: Overall, women who had a positive culture result from their index visit to the emergency department returned to the ED within 3 months for any reason or for a urinary complaint at the same rate as women with negative cultures. Those with positive cultures had a higher median number of urine studies performed and were also more likely to have a subsequent positive urine culture within 3 months.

Table 1: 3 month follow-up by culture positivity