(Poster 117) Prevention in Practice: Determinants of Counseling for Recurrent UTIs

Objectives: Patients with recurrent urinary tract infections (UTIs) often report dissatisfaction with discussion of prevention strategies during clinical encounters. The primary aim of this study was to compare the rate of evidence-based rUTI prevention methods prescribed across clinical specialties. We also examined demographic and clinical variables associated with estrogen prescription for rUTI.

Methods: We conducted a retrospective cohort study of 175 patients aged > 65 years with recurrent UTI treated with antibiotics, defined as >2 infections in six months or >3 in one year. We reviewed medical records to identify the specialty of clinicians prescribing antibiotics for UTIs in the year prior to diagnosis and the first specialty to recommend prevention strategies, including prescription options (vaginal estrogen, methenamine) and over-the-counter options (cranberry extract, D-mannose). Specialties were categorized as UTI specialists (urogynecology, urology) or non-specialists (primary care, obstetrics-gynecology, other). We compared demographic and clinical characteristics between patients who were prescribed estrogen and those who were not.

Results: Among 175 patients (median age 76), a total of 454 UTI episodes were treated with antibiotics. Non-specialists treated 76% (n=345) of these episodes (62% primary care, 9% obstetrics-gynecology, 2% other), while specialists treated 24% (16% urogynecology, 8% urology). Of all patients, 68.5% (n=120) were prescribed vaginal estrogen; among them, 74% received it from specialists (40% urogynecology, 34% urology), and 24% from non-specialists (13% primary care, 11% obstetrics-gynecology, 2% other) (Table 1). Patients prescribed estrogen were significantly more likely to have seen a specialist (82% vs 24%, p < .001) and less likely to have a caregiver (25% vs 47%, p < .001) (Table 1). They were also more likely to be prescribed additional prevention therapies: methenamine (p < .001), D-mannose (p < .001), and cranberry extract (p=.014) (Table 1). Patients who had never seen a specialist were significantly less likely to receive any evidence-based prevention methods, including methenamine (p < .001), D-mannose (p < .001), or cranberry extract (p < .001) (table 2).

Conclusions: Although most acute UTIs are managed by non-specialists, patients who have not been evaluated by a urologist or urogynecologist are significantly less likely to be offered estrogen or other evidence-based therapies to prevent recurrent UTIs. This highlights an opportunity to better equip busy primary care providers and general OB/GYNs with easy-to-use resources for implementing guideline-based prevention strategies. Additionally, patients who are already using estrogen may be more receptive to non-antibiotic prevention strategies and should therefore be offered multi-modal prevention approaches. Furthermore, patients with caregivers may encounter barriers to vaginal estrogen use and could benefit from more easily administered formulations, such as the vaginal estrogen ring.