Appropriateness of Urinary Tract Infection Diagnosis and Treatment Duration | Infectious Diseases | JAMA Internal Medicine | JAMA Network
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Research Letter
March 8, 2010

Appropriateness of Urinary Tract Infection Diagnosis and Treatment Duration

Author Affiliations

Author Affiliations: Minneapolis Veterans Affairs Medical Center (Drs Drekonja, Kuskowski, and Johnson) and Departments of Medicine (Drs Drekonja and Johnson) and Psychiatry (Dr Kuskowski) and University of Minnesota Medical School (Ms Okoye), University of Minnesota, Minneapolis.

Arch Intern Med. 2010;170(5):489-490. doi:10.1001/archinternmed.2009.543

Although urinary tract infection (UTI) is a frequent indication for antimicrobial therapy, the appropriateness of diagnosis and treatment duration is largely unknown.1 High-quality evidence supports withholding antimicrobial agents for asymptomatic bacteriuria and/or pyuria; similar evidence supports short-duration therapy in women with uncomplicated UTI.2,3 The optimal treatment duration for men (or women with complicating conditions) with UTI is less well defined, although available evidence and expert opinion suggest that longer treatment durations are needed.4-6 However, it is unknown to what extent these recommendations are followed.

We retrospectively reviewed records of ambulatory patients diagnosed as having UTI at the Minneapolis Department of Veterans Affairs Medical Center (MVAMC) to determine the frequency of inappropriate UTI diagnosis (ie, receiving therapy for UTI in the absence of clinical manifestations), nonrecommended treatment duration (according to sex and presence or absence of complicating conditions [eTable 1]), and practice variability. Assessed outcomes were retreatment and adverse drug events (ADEs), including Clostridium difficile infection, 30 days after therapy. Any documentation of a conceivably relevant symptom or finding (eTable 2) qualified a UTI diagnosis as appropriate. Based on available evidence and expert opinion, we defined appropriate treatment duration as follows: if no complicating conditions, 3 days (women) or 7 days (men); if complicating conditions, 7 days (women) or 10 to 14 days (men).4-6 A sensitivity analysis was performed, in which a less-restrictive definition of appropriate treatment duration was used (3 days for women without complicating conditions; otherwise, 7-14 days).