Dissertation
Treatment of inpatient urinary tract infections and patterns of the pathogens that cause urinary tract infections
University of Iowa
Doctor of Philosophy (PhD), University of Iowa
Spring 2022
DOI: 10.25820/etd.006545
Abstract
Urinary tract infections (UTIs) are one of the most common bacterial infections, and they account for over $2.6 billion in annual costs in the United States. UTIs account for roughly 7 million office visits, 1 million emergency department visits, and over 100,000 hospitalizations each year. UTI are effectively treated with antibiotics. However, antibiotic resistance has affected the prescribing patterns of physicians. UTI-causing pathogens have mostly been studied in an outpatient setting. Yet the outpatient and inpatient setting may have different risk factors. For example, elderly patients are more likely to be hospitalized with a UTI than younger patients. Another unique factors about UTIs is that they are seasonal and are more common during the summer months. However, it is unknown if specific UTI-causing pathogens are driving the seasonal trend or if all UTI-causing pathogens follow this trend.
For this study, we selected UTI patients who were hospitalized and had a urine culture associated with that hospitalization. We looked at the antibiotics that they received during their hospitalization and described how treatment changed over the hospitalization. We examined different definitions of resistance and how resistance varied by hospital characteristics and across different geographic regions. We then described the seasonality of all UTIs and the three most common UTI-causing pathogens.
We observed that the most common antibiotics prescribed in the inpatient setting were ceftriaxone, levofloxacin, and ciprofloxacin. We found that it was common for patients that were started on these antibiotics to experience a switch to a different antibiotic during their stay. The most common type of UTI-causing organism in this sample was Escherichia coli, followed by Klebsiella pneumoniae, and Proteus mirabilis.
We found that urban areas did not have significantly higher rates of antibiotic resistance when compared to rural areas. However, we did find that antibiotic resistance was higher for mid-sized hospitals. We found that antibiotic resistance patterns varied by census region as well as by metropolitan statistical area.
Lastly, we found that UTIs are seasonal but it did not appear that any particular pathogen was driving the overall seasonal trend. We found that females were more affected by the seasonal trend than males overall. Being able to understand the seasonality of UTIs is important to learn how to dampen the seasonal increase. If we can reduce the seasonal increase, fewer patients will have a UTI and be exposed to antibiotics.
Details
- Title: Subtitle
- Treatment of inpatient urinary tract infections and patterns of the pathogens that cause urinary tract infections
- Creators
- Kendra Yvette Foster
- Contributors
- Linnea Polgreen (Advisor)Erika Ernst (Committee Member)Brett Faine (Committee Member)Philip Polgreen (Committee Member)Jacob Simmering (Committee Member)
- Resource Type
- Dissertation
- Degree Awarded
- Doctor of Philosophy (PhD), University of Iowa
- Degree in
- Pharmacy
- Date degree season
- Spring 2022
- Publisher
- University of Iowa
- DOI
- 10.25820/etd.006545
- Number of pages
- viii, 72 pages
- Copyright
- Copyright 2022 Kendra Yvette Foster
- Language
- English
- Description illustrations
- color illustrations, color maps
- Description bibliographic
- Includes bibliographical references (pages 68-72).
- Public Abstract (ETD)
Urinary tract infections (UTIs) are a common bacterial infection that can lead to hospitalization. Antibiotics are used to treat UTIs. However, inappropriate use of antibiotics can lead to pathogens becoming resistant to antibiotics making treatment ineffective.
We studied hospitalized patients that were diagnosed with a UTI and had a urine culture so that the UTI-causing pathogen was known. We first determine what antibiotics these patients were receiving and how that changed over the course of the hospitalization. We found that the most common antibiotics were ceftriaxone, levofloxacin, and ciprofloxacin. We also found that switching to a different antibiotic was common.
We then studied resistance patterns across the United States. We looked at resistance patterns by different hospital characteristics like urban or rural location, type of hospital, and hospital size. We found that there was little difference in the resistance rates by any of these characteristics which means that this a problem that exists everywhere. Resistance is often thought of as an urban problem, but that is not how we should be creating policies and guidelines to combat the growing problem of antibiotic resistance.
Seasonality, or a cycle of high and low incidence, of UTIs has been recognized but the cause is not fully understood. We studied different pathogens that caused UTIs to determine if the seasonality was being driven by one pathogen or if all pathogens followed this cycle. I found that seasonality existed for every pathogen examine, implying that most UTIs are seasonal and peak in the summer.
- Academic Unit
- Pharmacy
- Record Identifier
- 9984271454702771
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