Microbiology Testing and Oral Antibiotic Treatment Among CKD Patients With Urinary Tract Infections: Real-World Evidence From a US EMR Network
Author(s)
Seth Kuranz1, Virginia Noxon, PhD2.
1Senior Director, Clinical Analytics, Inovalon, Bowie, MD, USA, 2Inovalon, Bowie, MD, USA.
1Senior Director, Clinical Analytics, Inovalon, Bowie, MD, USA, 2Inovalon, Bowie, MD, USA.
OBJECTIVES: Few real-world evidence studies have examined oral antibiotic treatment (oABXtx) among patients with chronic kidney disease (CKD). This study explores the timing of microbiology testing and oABXtx among CKD patients with urinary tract infections (UTI).
METHODS: Patients with stage 3 CKD [estimated glomerular filtration rate (eGFR): ≥30 and <60 mL/min/1.73m2)] were identified using electronic medical records from a US-based network of acute and critical care facilities. Between January 1, 2017, and October 31, 2024, patients had an inpatient or emergency department (ED) visit with an associated UTI diagnosis, positive urine culture with an identified organism, and oABXtx. Differences by sex and treatment setting were described.
RESULTS: Patients (female: n=8,573; male: n=3,611) had a total of 12,368 inpatient (84.6%) and ED (15.4%) visits. Compared to males, females were younger (70.9±13.0 vs. 72.6±10.7), more likely to be White (83% vs. 80%), and less likely to be Black (8% vs. 12%). Escherichia coli and Klebsiella pneumoniae were the most common organisms identified in urine cultures. The most common result for a tested oABXtx was “Susceptible” (inpatient: 64.1% of female and 59.4% of male cultures; ED: 76.0% of female and 80.6% of male cultures). Most oABXtx occurred after receipt of the testing results in inpatient settings (female: 72%; male: 76%) but was uncommon in ED settings (female: 13%; male: 12%). On average, oABXtx occurred 0.7±2.7 and 1.0±3.3 days after microbiology results in inpatient settings and 1.5±2.0 and 1.6±1.6 days before microbiology results in ED settings for females and males, respectively. Alignment of oABXtx with testing results was more likely in inpatient (45%) than ED (28%) settings (p<0.05).
CONCLUSIONS: Microbiology testing results may not contribute to the initial oABXtx decision. Future studies in UTI and oABXtx should incorporate microbiology result timing in determining UTI outcomes and examine the resulting patient burden and associated costs.
METHODS: Patients with stage 3 CKD [estimated glomerular filtration rate (eGFR): ≥30 and <60 mL/min/1.73m2)] were identified using electronic medical records from a US-based network of acute and critical care facilities. Between January 1, 2017, and October 31, 2024, patients had an inpatient or emergency department (ED) visit with an associated UTI diagnosis, positive urine culture with an identified organism, and oABXtx. Differences by sex and treatment setting were described.
RESULTS: Patients (female: n=8,573; male: n=3,611) had a total of 12,368 inpatient (84.6%) and ED (15.4%) visits. Compared to males, females were younger (70.9±13.0 vs. 72.6±10.7), more likely to be White (83% vs. 80%), and less likely to be Black (8% vs. 12%). Escherichia coli and Klebsiella pneumoniae were the most common organisms identified in urine cultures. The most common result for a tested oABXtx was “Susceptible” (inpatient: 64.1% of female and 59.4% of male cultures; ED: 76.0% of female and 80.6% of male cultures). Most oABXtx occurred after receipt of the testing results in inpatient settings (female: 72%; male: 76%) but was uncommon in ED settings (female: 13%; male: 12%). On average, oABXtx occurred 0.7±2.7 and 1.0±3.3 days after microbiology results in inpatient settings and 1.5±2.0 and 1.6±1.6 days before microbiology results in ED settings for females and males, respectively. Alignment of oABXtx with testing results was more likely in inpatient (45%) than ED (28%) settings (p<0.05).
CONCLUSIONS: Microbiology testing results may not contribute to the initial oABXtx decision. Future studies in UTI and oABXtx should incorporate microbiology result timing in determining UTI outcomes and examine the resulting patient burden and associated costs.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
EPH150
Topic
Epidemiology & Public Health
Topic Subcategory
Disease Classification & Coding, Safety & Pharmacoepidemiology
Disease
SDC: Infectious Disease (non-vaccine), SDC: Urinary/Kidney Disorders