OBJECTIVES: Guideline-directed empiric treatment decisions in uncomplicated urinary tract infections (uUTIs) may minimize the occurrence of treatment failure (TF), thus curtailing suboptimal outcomes. This study aimed to identify the incidence of, and risk factors for, empiric TF in females with uUTI treated within a US Integrated Delivery Network (IDN).

METHODS: De-identified electronic health record (EHR) data between 1/1/2017–1/31/2023 from a world-renowned US IDN were utilized to identify uUTI TF in females aged ≥12 years. Eligibility criteria included: ≥1 uUTI outpatient diagnosis, ≥1 empiric antibiotic prescription ±5 days of diagnosis (initial prescription date = index date) and ≥12 months of EHR activity both pre-/post-index. TF was defined as ≥1 of the following ≤28 days post-index: additional oral antibiotic prescription, intravenous antibiotic administration, or emergency department (ED) or inpatient stay with primary diagnosis of UTI (index uUTI excluded). Risk factors for TF were examined using logistic regression.

RESULTS: The female uUTI study population (n=28,460) was predominantly White (95%) and averaged 51.6 years old. TF occurred in 15.2% (n=4330) of patients, primarily based on the need for additional oral antibiotics (14.8%; n=4207). The odds of TF were significantly greater (all p-values <0.001) for patients prescribed fosfomycin (odds ratio [OR]:4.11, 95% confidence interval [CI]:2.53–6.67; reference=nitrofurantoin), with uro-/nephro-logical procedures >28 days pre-index (OR:2.26, 95%CI:1.91–2.67), in age groups ≥50 years (e.g., ≥75 years, OR:2.15, 95%CI:1.78–2.60; reference=12–17), with ≥1 pre-index hospitalization (OR:1.87, 95%CI:1.65–2.11), with any prior antibiotic resistance (OR:1.81, 95%CI:1.61–2.04), and with recurrent UTI (OR:1.71, 95%CI:1.55–1.89). Use of ED for index visit, ≥1 baseline ED visit, and ≥2 baseline oral antibiotic prescriptions were also associated with statistically significantly higher odds of TF.

CONCLUSIONS: Clinicians should consider risk factors among females with uUTI to identify patients at increased risk of TF to empiric treatment.