Introduction

Evidence-based screening and treatment for bacteriuria is crucial to prevent antibiotic overuse and increasing antimicrobial resistance. The Infectious Disease Society of America (IDSA) released guidelines in 2005 and 2011 on the management of asymptomatic bacteriuria (ASB) and uncomplicated urinary tract infections (UTIs) in women. We hypothesized that these guidelines have not been widely adopted. This study assessed physicians’ practices in screening and treating women with bacteriuria relative to guideline recommendations.

Methods

Between 7/2016 and 10/2016, cross-sectional data from physicians in relevant fields were collected using an anonymous questionnaire. Multivariable logistic regression analysis identified independent predictors of adherence to guidelines for ASB and uncomplicated UTIs in women.

Results

Data were collected from 260 physicians (29.6% internal medicine, 29.6% urology, 25.8% OBGYN, 9.2% emergency medicine, 5.8% family medicine). Over half of physicians surveyed were unfamiliar with the IDSA guidelines (56.9%) and overtreated ASB, or selected to give an antibiotic in a clinical scenario in which antibiotics were not indicated (54.7%). Independent variables associated with overtreating ASB included a non-academic practice (OR 3.23, p= 0.024) and practicing as an OBGYN (OR 3.65, p= 0.006). Urologists were more likely to report prescribing antibiotics in clinical scenarios where treatment is recommended by the IDSA (OR 6.50, p< 0.001). Nearly one third (30.1%) of physicians reported prescribing an antibiotic other than a recommended first-line agent for uncomplicated UTIs, including 8.1% who chose a fluoroquinolone. OBGYNs and urologists were more likely to prescribe a recommended first-line agent to women with uncomplicated UTIs (OBGYNs: OR 21.01, p< 0.001; urologists: OR 2.37, p= 0.044) compared to internists. Of those who correctly selected a first-line agent, 29.8% prescribed a longer than recommended duration of therapy. IDSA guideline awareness was not associated with physicians' practices in managing women with bacteriuria.

Conclusions

Most physicians surveyed were unfamiliar with guidelines related to managing ASB and uncomplicated UTIs in women, likely contributing to overscreening and overtreatment of ASB and the use of inappropriate antibiotic regimens in treating uncomplicated UTIs. However, superior antibiotic stewardship was not associated with knowledge of IDSA guidelines, suggesting that guideline dissemination alone may not alter practice patterns among physicians managing women with bacteriuria.

Funding

None