Risk factors for treatment failure in women with uncomplicated lower urinary tract infection.

Romain Martischang,Shachaf Shiber,Maciek Godycki-Ćwirko,Katarzyna Kosiek,Anna Kowalczyk,Leonard Leibovici,Tanya Babich,Adi Turjeman,Elodie Von Dach,Stephan Harbarth,Angela Huttner

doi:10.1371/journal.pone.0256464

Abstract

Given rising antibiotic resistance and increasing use of delayed prescription for uncomplicated lower urinary tract infections (UTI), patients at risk for treatment failure should be identified early. We assessed risk factors for clinical and microbiological failure in women with lower UTI. This case-control study nested within a randomized clinical trial included all women in the per-protocol population (PPP), those in the PPP with microbiologically confirmed UTI, and those in the PPP with UTI due to Escherichia coli. Cases were women who experienced clinical and/or microbiologic failure; controls were those who did not. Risk factors for failure were assessed using multivariate logistic regression. In the PPP, there were 152 clinical cases for 307 controls. Among 340 women with microbiologically confirmed UTI, 126 and 102 cases with clinical and microbiological failure were considered with, respectively, 214 and 220 controls. Age ≥52 years was independently associated with clinical (adjusted OR 3.01; 95%CI 1.84-4.98) and microbiologic failure (aOR 2.55; 95%CI 1.54-4.25); treatment with fosfomycin was associated with clinical failure (aOR 2.35; 95%CI 1.47-3.80). The association with age persisted among all women, and women with E. coli-related UTI. Diabetes was not an independent risk factor, nor were other comorbidities. Postmenopausal age emerged as an independent risk factor for both clinical and microbiological treatment failure in women with lower UTI and should be considered to define women at-risk for non-spontaneous remission, and thus for delayed antibiotic therapy; diabetes mellitus was not associated with failure.

Highlights

Acute, uncomplicated lower urinary-tract infection (UTI) is one of the most frequent indications for antibiotic prescription among healthy women [1]
At the same time, delayed antibiotic treatment strategies [3] are being increasingly used for this mucosal infection given its sizeable rate of spontaneous remission [4, 5], the low risk of progression to pyelonephritis [1], and clear evidence that frequent antimicrobial therapy increases the risk of acquiring multi-resistant organisms [6, 7]
Participants were randomly assigned to macrocrystalline nitrofurantoin 100 mg 3 times a day for 5 days or a single 3-g dose of oral fosfomycin and followed clinically and microbiologically at 14 (±2) and 28 (±7) days after completion of antibiotic therapy

Summary

Introduction

Acute, uncomplicated lower urinary-tract infection (UTI) is one of the most frequent indications for antibiotic prescription among healthy women [1]. With their widespread use, there is increasing resistance to fosfomycin and nitrofurantoin [2], the two antibiotics currently recommended as first-line therapy [1]. At the same time, delayed antibiotic treatment strategies [3] are being increasingly used for this mucosal infection given its sizeable rate of spontaneous remission [4, 5], the low risk of progression to pyelonephritis [1], and clear evidence that frequent antimicrobial therapy increases the risk of acquiring multi-resistant organisms [6, 7]. Treatment failure was defined heterogeneously, and follow-up bacteriologic data were rarely available [15]

Methods

Results

Discussion

Conclusion