#39: How UTIs Have Evolved with Antibiotic Stewardship

 Dr. Boghuma Titanji, a third-year Internal Disease fellow at Emory University in Atlanta, defines Urinary Tract Infections as significant bacteriuria plus specific signs and symptoms that localize to the urinary tract.  To take it a step further she proceeds to break it down to complicated and uncomplicated UTIs.  Uncomplicated UTIs are those with the localization of signs and symptoms being limited to the bladder and below, with the patient having no other systemic symptoms.  Conversely complicated UTIs would have signs and symptoms localizing above the bladder which could lead to more serious deep seeded infections.  This difference is important when deciding upon the antibiotic to be used to treat the UTI.  Many times providers will choose not to do any labs on a “simple uncomplicated UTI”.  It may interest you to know that 60% of women who present with a UTI will have a recurrence within 6 months.  That is a high number.  Depending upon how quickly the UTI returns the quandary becomes, “Is this a recurrence or is this a relapse?” 

I pose the question, “Does it really matter?”  Standard of care dictates that if the patient returns with a UTI after three months of complete resolution of the first one, the course of treatment is the same as the first time.  If they return a third time after complete resolution it is then one should consider getting a lab test to determine what they are growing so you can be more targeted and careful with your antibiotic selection.   Why not send for a PCR test the first time to use the correct antibiotic from the beginning?  Perhaps you would be able to eliminate the recurrent episodes. 

Now that I have stirred up all kinds of sentiments, I emphasize my goal with these blogs is to make one think critically about how they treat their patients.  Additionally, I am all about antibiotic stewardship as I have mentioned before.  If there is a way to decrease the amount of antibiotics patients are given and still treat them appropriately I want to know.  One of my professors in school used the following quote frequently when we crawled into our comfortable little boxes and he wished us to think outside them, “Doctors are products of their training!”  We are taught if A then B, and many of us are guilty of hanging on to that logic throughout our careers.  The only constant thing in life is change and medicine is a reflection of that.  In the last thirty years, the treatments and tests for UTIs have evolved.  With all of the weapons (antibiotics), we have at our disposal to treat them we must have the knowledge to choose the most efficacious one.  With the use of PCR, the pathogen is defined quickly and antibiotic resistance is reported so the weapon you choose is correct the first time.  As always, ILDP appreciates your business and I personally wish you and your loved ones health and happiness. 

Thank you.

 

Lance Benedict

President/CEO Industry Lab Diagnostic Partners