title: Outcome of nonadherence to antimicrobial treatment guidelines in ambulatory patients with acute cystitis: a nationwide population-based study.
abstract: OBJECTIVE
  The recurrence rate after acute cystitis treatment failure with inappropriate antimicrobials remains unclear. The goal of this study was to explore the relationship between cystitis recurrence and nonadherence of antimicrobial prescriptions to national guidelines using a nationwide population-based data set.
  
  
  METHODS
  This was a retrospective longitudinal observational cohort study that was conducted using the clinical records of the National Health Insurance Research Database in Taiwan from 2006-2007. After excluding patients younger than 18 years of age, with concurrent infections, urinary tract anomaly, and no antimicrobial treatment, the remaining study population included 36,395 patients with acute cystitis. We evaluated the hazard ratio (HR) of cystitis recurrence within 28 days between the adherence and nonadherence groups using Cox proportional hazard regression analysis.
  
  
  RESULTS
  Adherence to antimicrobial prescription guidelines was the factor that most strongly influenced acute cystitis recurrence, with a HR of 0.91 (95% confidence interval 0.87-0.95) after adjusting for all variables. The incidence rate of acute cystitis in patients receiving antimicrobials adherent to national guidelines was 59.78 per 10,000 person-days. The results of the likelihood ratio test indicated that age, sex, and guideline nonadherence were significant risk factors for recurrent cystitis. The percentage of first-generation cephalosporin prescription was 31.61%, making it the most frequently prescribed guideline-recommended drug.
  
  
  CONCLUSIONS
  Acute cystitis patients with or without multiple chronic comorbidities should be treated with antimicrobials that adhere to recommended guidelines to attain a better therapeutic outcome.
authors.affiliation: School of Public Health, College of Public Health and Nutrition, Taipei Medical University, Taiwan.
authors.forename: Hsiu-Chen
authors.initials: HC
authors.lastname: Lin
authors.forename: Hsiu-Li
authors.initials: HL
authors.lastname: Lin
authors.forename: Li-Hsuan
authors.initials: LH
authors.lastname: Wang
authors.forename: Chien-Yeh
authors.initials: CY
authors.lastname: Hsu
authors.forename: Yu-Mei
authors.initials: YM
authors.lastname: Hsueh
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D003556:Cystitis / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D010349:Patient Compliance; D011159:Population Surveillance; D017410:Practice Guidelines as Topic; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000890:Anti-Infective Agents