Best Practice Guidelines for Uncomplicated Urinary Tract Infections Reduce the Rates of Antibiotic Resistance: A CE Module for Clinicians

Abstract

            For the past two decades antibiotic resistance has become a global issue stemming from the overuse of antibiotics. The lack of appropriate management of the client with uncomplicated urinary tract infections (UTI’s) contributes to antibiotic overuse and an increase in antibiotic resistance. Uncomplicated UTI ranks as one of the most frequently treated diagnosis in primary care settings and urgent care clinics.  In fact, approximately one in six women will experience an uncomplicated UTI in her lifetime.

            More than eleven percent of women are diagnosed with uncomplicated UTI’s annually and many of these women are needlessly treated with antibiotics. The costs associated with the evaluation and treatment of uncomplicated UTI’s in women was estimated to be $3.5 million in 2000. The total cost associated with treatment of UTI’s in the emergency department has amounted to $4 billion dollars (Gregg, 2013). The expense of treating patients with uncomplicated UTI’s has continued to rise contributing to the astronomical cost of healthcare affecting insurance companies, individuals, and providers. A vast number of studies have shown that almost 50% of women presenting with symptoms of uncomplicated UTI will recover spontaneously within one week without antibiotics (Knottnerus et al., 2013; Leydon, Turner, Smith, & Little, 2009). However, providers continue to treat patients with uncomplicated UTI’s by prescribing antibiotics in spite of the recommendations from the current best practice guidelines.

Statement of purpose: A continuing education (CE) module targeting health care providers will provide the most current information about the proper treatment and management of uncomplicated UTI’s in women, which will result in a decrease in the incidence and prevalence of antibiotic resistance.  

Literature review. Research studies have shown an alarming increase in the rates of resistance against antibiotics that are commonly used to treat uncomplicated UTI’s in women. Empiric treatment of uncomplicated UTI’s has resulted in an increase in antibiotic resistance from 20% to 40% within the past decade in various regions of the United States (Ansbach, Dybus, and Bergeson, 2005). However, healthcare providers continue to prescribe a long-term course of antibiotic therapy for treatment of uncomplicated UTI’s instead of adhering to EBP guidelines. A comprehensive literature review has shown that short-term course antibiotic therapy is just as effective as the traditional long-course therapy for treatment of uUTI’s, and patients are more likely to complete the short-term course of treatment (Barclay, 2008; Kahan, Chinitz, & Kahan, 2004).

Theory. The development of this CE module will be based on concepts from Malcolm Knowles’ Adult Learning Theory. Knowles believed that adults are responsible for their own learning and are motivated by their need to know and internal drive (Norrie & Dalby, 2007). The CE module will be a self-directed learning experience at a time and place that is convenient for the participant.

Education module. The goal of this CE module is to increase provider awareness regarding the appropriate use of antibiotics and length of therapy for the treatment of uUTI’s in women in accordance with the latest EBP guidelines while reducing the risk of antibiotic resistance. The latest guidelines as set forth by the Infectious Disease Society of America (IDSA) in 2011 as well as the earlier 2008 guidelines developed by the American College of Obstetrics and Gynecologists (Gupta, Hooton, Naber, Wullt, Colgan, Miller, Soper, 2010). A pre-test, post-test method will be used. A multiple choice questionnaire consisting of 10-questions will be used to assess and to evaluate current knowledge, awareness, and practice behaviors regarding the use of antibiotics for the treatment of uUTI’s.

Summary. It is imperative the providers adhere closely to EBP guidelines for the proper management of uUTI’s  in women and they have a goal to minimize further development of antibiotic resistance. Increased adherence to EBP guidelines will reduce healthcare costs, decrease adverse reactions, minimize antibiotic use and ultimately impact the global issue of increasing antibiotic resistance.

References

Ansbach, R. K., Dybus, K., & Bergeson, R. (2005). Uncomplicated E. coli urinary tract infection in college women: a follow-up study of E. coli sensitivities to commonly prescribed antibiotics. Journal of American College Health, 54, 81-84.

Barclay, L. (2008). New guidelines for management of urinary tract infection in nonpregnant women. Retrieved from www.medscape.org/viewarticle/571545

Bjorkman, I., Berg, J., Viberg, N., & Lunborg, C. S. (2013). Awareness of antibiotic resistance and antibiotic prescribing in UTI treatment: A qualitative study among primary care physicians in Sweden. Scandinavian Journal of Primary Health Care, 31, 50-55.

Gupta, K., Hooton, T. M., Naber, K. G., Wullt, B., Colgan, R., Miller, L. G., Soper, D. E. (2010, March 1). International Clinical Practice Guidelines for the Treatment of Acute Uncomplicated Cystitis and Pyelonephritis in Women: A 2010 Update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clinical Practice Guidelines, 201, e103-120. Retrieved from http://www.idsociety.org/uploadedFiles/IDSA/Guidelines-Patient_Care/PDF_Library/Uncomp%20UTI.pdf

Gregg, H. (2013, May). ER visits for UTIs add $4B in unnecessary healthcare costs annually. Retrieved from http://www.beckershospitalreview.com/quality/er-visits-for-utis-add-4b-in-unnecessary-healthcare-costs-annually.html

Kahan, N. R., Chinitz, D. P., & Kahan, E. (2004). Longer than recommended empiric antibiotic treatment of urinary tract infection in women: an avoidable waste of money. Journal of Clinical Pharmacy and Therapeutics, 29, 59-63.

Knottnerus, B. J., Geerlings, S. E., Moll van Charante, E. P., & ter Riet, G. (2013, May 31st). Women with symptoms of uncomplicated urinary tract infection are often willing to delay antibiotic treatment: A prospective cohort study. BMC Family Practice.

Leydon, G. M., Turner,. S., Smith, H., & Little, P. (2010). Women’s views about management and cause of urinary tract infection: Qualitative interview study.

Mangin, D., Murdoch, D., Wells, J. E., Coughlan, E., Bagshaw, S., Corwin, P., Toop, L. (2012). Chlamydia trachomatis Testing sensitivity in midstream compared with first-void urine specimens. Annals of Family Medicine, 10, 50-53.

Norrie, P., & Dalby, D. (2007). How adult are our learners? Journal of Research in Nursing, 12, 319-329. http://dx.doi.org/10.1177/1744987107075254