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. 2015 Dec;70(12):3397-400.
doi: 10.1093/jac/dkv271. Epub 2015 Sep 7.

Perceptions and behaviours of infectious diseases physicians when managing urinary tract infections due to MDR organisms

Sergio E Trevino  1 , Hilary M Babcock  1 , Jeffrey P Henderson  1 , Michael A Lane  1 , Susan E Beekmann  2 , Philip M Polgreen  2 , Jonas Marschall  3
Affiliations

Perceptions and behaviours of infectious diseases physicians when managing urinary tract infections due to MDR organisms

Sergio E Trevino et al. J Antimicrob Chemother. 2015 Dec.

Abstract

Objectives: The objective of this study was to attain a better understanding of infectious diseases (ID) physicians' experience with MDR organism (MDRO) urinary tract infections (UTIs) by means of a survey on disease perception, diagnostic management and treatment preferences.

Methods: A nine-question survey was developed and distributed to members of the North American Emerging Infections Network (EIN) in September 2013.

Results: Seven hundred and fourteen out of 1461 EIN members responded to the survey (49%). The responses of 603 responders were studied. Most providers perceived an increase in the incidence of MDRO UTIs over the past 3 years (75% of adult ID responders and 63% of paediatric ID responders). One hundred and thirty-four (22%) responders prefer intravenous over oral administration of antimicrobials when both are available, 171 (28%) prefer longer durations of therapy when comparing an MDRO with a susceptible isolate of the same species and 142 (24%) order a repeat urine culture as 'proof of cure' after treating an MDRO UTI. Nevertheless, 530 (88%) responders perceived MDRO UTIs to be of similar severity as non-MDRO UTIs. Fifty-five percent of providers prescribed fosfomycin for MDRO UTI at least once; the most common prescribing pattern (among a wide spectrum of approaches) was a single dose (16%).

Conclusions: Future studies on MDRO UTIs should clarify the role of resistance in patient outcomes and the comparative efficacy of different antimicrobials. Of particular interest is fosfomycin, which is unrelated to other antibiotic classes and may take a more prominent role in treating MDRO cystitis.

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Figures

Figure 1.
Figure 1.
Provider ranking of the most frequently encountered organisms in MDRO UTIs. Inverse median and inverse mean = the median and mean values were inverted 1/x to yield higher values for more important criteria; n = number of respondents for each category of antibiotic-resistant organisms shown. ESBL, ESBL-producing Enterobacteriaceae.
Figure 2.
Figure 2.
Preferred treatment duration for lower UTI due to different organisms. ESBL, ESBL-producing Enterobacteriaceae.
See this image and copyright information in PMC

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