title: Urinary tract infection in male veterans: treatment patterns and outcomes.
abstract: BACKGROUND
  Lengthier antimicrobial therapy is associated with increased costs, antimicrobial resistance, and adverse drug events. Therefore, establishing minimum effective antimicrobial treatment durations is an important public health goal. The optimal treatment duration and current treatment patterns for urinary tract infection (UTI) in men are unknown. We used Veterans Affairs administrative data to study male UTI treatment and outcomes.
  
  
  METHODS
  Male UTI episodes in the Veterans Affairs system (fiscal year 2009) were identified by combining International Classification of Diseases, Ninth Revision codes with UTI-relevant antimicrobial prescriptions. Episodes were categorized as index, early recurrence (<30 days), or late recurrence (≥30 days) cases. Drug name, treatment duration, and outcomes (recurrence and Clostridium difficile infection during 12 months) were recorded for index cases. Demographic, clinical, and treatment characteristics were assessed for associations with outcomes in univariate and multivariate analyses.
  
  
  RESULTS
  Among 4 854 765 outpatient male veterans, 39 149 UTI episodes involving 33 336 unique patients were identified, including 33 336 index cases (85.2%), 1772 early recurrences (4.5%), and 4041 late recurrences (10.3%). Highest-use antimicrobial agents were ciprofloxacin (62.7%) and trimethoprim-sulfamethoxazole (26.8%); 35.0% of patients received shorter-duration treatment (≤7 days), and 65.0% of patients received longer-duration treatment (>7 days). Of the index cases, 4.1% were followed by early recurrence and 9.9% by late recurrence. Longer-duration treatment was not associated with a reduction in early or late recurrence but was associated with increased late recurrence compared with shorter-duration treatment (10.8% vs 8.4%, P < .001), including in multivariate analysis (odds ratio, 1.20; 95% CI, 1.10-1.30). In addition, C difficile infection risk was significantly higher with longer-duration vs shorter-duration treatment (0.5% vs 0.3%, P = .02) and exhibited a similar suggestive trend in multivariate analysis (odds ratio, 1.42; 95% CI, 0.97-2.07).
  
  
  CONCLUSIONS
  Longer-duration treatment (>7 days) for male UTI in the outpatient setting was associated with no reduction in early or late recurrence.
authors.affiliation: Minneapolis Veterans Affairs Health Care System, Minneapolis, MN 55417, USA. drek0002@umn.edu
authors.forename: Dimitri M
authors.initials: DM
authors.lastname: Drekonja
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Rector
authors.forename: Andrea
authors.initials: A
authors.lastname: Cutting
authors.forename: James R
authors.initials: JR
authors.lastname: Johnson
mesh_terms: D000368:Aged; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000009:adverse effects; D002939:Ciprofloxacin / Q000008:administration & dosage / Q000009:adverse effects; D003015:Clostridium Infections / Q000188:drug therapy / Q000453:epidemiology; D015897:Comorbidity; D004334:Drug Administration Schedule; D004352:Drug Resistance, Microbial; D017050:Episode of Care; D006801:Humans; D008297:Male; D054539:Medication Therapy Management / Q000592:standards / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care; D055502:Secondary Prevention; D013997:Time Factors; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000008:administration & dosage / Q000009:adverse effects; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data; D014552:Urinary Tract Infections / Q000188:drug therapy / Q000453:epidemiology; D014728:Veterans
chemical_list: D000890:Anti-Infective Agents; D002939:Ciprofloxacin; D015662:Trimethoprim, Sulfamethoxazole Drug Combination