title: Assessing adherence to evidence-based guidelines for the diagnosis and management of uncomplicated urinary tract infection.
abstract: OBJECTIVE
  To assess adherence to evidence-based guidelines for the diagnosis and management of uncomplicated urinary tract infection (UTI) in a family medicine residency clinic setting.
  
  
  METHODS
  We retrospectively reviewed the medical records of female patients seen in 2005 at the Mayo Clinic Family Medicine Center in Scottsdale, Ariz, who were identified by International Classification of Diseases, Ninth Revision code 599.0 (UTI). We assessed documentation rates, use of diagnostic studies, and antibiotic treatments. Antibiotic sensitivity patterns from outpatient urine culture and sensitivity analyses were determined.
  
  
  RESULTS
  Of 228 patients, 68 (30%) had uncomplicated UTI. Our physicians recorded essential history and examination findings for most patients. Documentation of the risk of sexually transmitted disease differed between residents and attending physicians and was affected by patient age. Urine dipstick and urine culture and sensitivity analyses were ordered in 57 (84%) and 52 (76%) patients, respectively. Eighty percent of patients with positive results on urine dipstick analyses also had urine culture and sensitivity analyses. Sulfamethoxazole-trimethoprim (SMX-TMP) was used as initial therapy in 26 patients (38%). Sixty-one percent of SMX-TMP and ciprofloxacin prescriptions were appropriately provided for 3 days. Escherichia coil was sensitive to SMX-TMP in 33 (94%) of 35 cultures. Treatment was not changed in any patient with an uncomplicated UTI because of results of urine culture and sensitivity analyses. Antibiotic sensitivity patterns for outpatients were significantly different from those for inpatients.
  
  
  CONCLUSIONS
  Only 30% of our patients had uncomplicated UTI, making their management within clinical guidelines appropriate. However, of those patients with uncomplicated UTI, less than 25% received empirical treatment as suggested. Urine culture and sensitivity analyses were performed frequently, even in patients who already had positive results on a urine dip-stick analysis. Although SMX-TMP is effective, it is underused. On the basis of these findings, we hope to provide interventions to increase SMX-TMP prescription, decrease use of urine culture and sensitivity analyses, and increase the frequency of 3-day antibiotic treatments at our institution.
authors.affiliation: Department of Family Medicine, Mayo Clinic College of Medicine, 13737 N 92nd St, Scottsdale, AZ 85260, USA. grover.michael@mayo.edu
authors.forename: Michael L
authors.initials: ML
authors.lastname: Grover
authors.forename: Jesse D
authors.initials: JD
authors.lastname: Bracamonte
authors.forename: Anup K
authors.initials: AK
authors.lastname: Kanodia
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Bryan
authors.forename: Sean P
authors.initials: SP
authors.lastname: Donahue
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Warner
authors.forename: Frederick D
authors.initials: FD
authors.lastname: Edwards
authors.forename: Amy L
authors.initials: AL
authors.lastname: Weaver
mesh_terms: D000328:Adult; D000892:Anti-Infective Agents, Urinary / Q000008:administration & dosage / Q000627:therapeutic use*; D015331:Cohort Studies; D004334:Drug Administration Schedule; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008499:Medical Records; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D010808:Physical Examination; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000008:administration & dosage / Q000627:therapeutic use*; D014552:Urinary Tract Infections / Q000175:diagnosis* / Q000188:drug therapy* / Q000382:microbiology
chemical_list: D000892:Anti-Infective Agents, Urinary; D015662:Trimethoprim, Sulfamethoxazole Drug Combination