Alexander B Chew1, Katie J Suda2,3, Ursula C Patel1, Margaret A Fitzpatrick2,4, Swetha Ramanathan2, Stephen P Burns5,6, Charlesnika T Evans2,7. 1. a Pharmacy Service, Edward Hines, Jr. Veterans Affairs Hospital , Hines , Illinois, USA. 2. b Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. Veterans Affairs Hospital , Hines , Illinois, USA. 3. c Department of Pharmacy Systems, Outcomes, and Policy , University of Illinois at Chicago , Chicago , Illinois, USA. 4. d Department of Medicine , Loyola University Stritch School of Medicine , Maywood , Illinois, USA. 5. e Spinal Cord Injury Service, VA Puget Sound Health Care Service , Seattle , Washington, USA. 6. f Department of Rehabilitation Medicine , University of Washington , Seattle , Washington, USA. 7. g Department of Preventive Medicine and Center for Healthcare Studies , Northwestern University , Chicago , Illinois, USA.
Abstract
CONTEXT/ OBJECTIVE: To evaluate the impact of long-term nitrofurantoin for UTI prophylaxis in veterans with SCI. DESIGN: Matched pairs study. SETTING: Veterans cared for at VA facilities from 10/1/2012-9/30/2013. PARTICIPANTS: Veterans. INTERVENTIONS: n/a. OUTCOMES MEASURES: UTI, positive urine cultures, resistant cultures. METHODS: Cases receiving long-term nitrofurantoin (≥90 days supply) were matched to controls by facility. Controls were patients who did not receive long-term nitrofurantoin with a history of ≥3 positive urine cultures and at least one diagnosis of UTI or asymptomatic bacteriuria in the previous year. RESULTS: 122 SCI cases were identified and matched to 196 controls. After adjusting for differences in baseline demographic characteristics, UTIs were less frequent in cases (OR = 0.60 [95% CI 0.44-0.72]). Cases had a greater mean number of days between positive urine cultures as compared to controls (<0.0001). Cases were more likely to have isolates resistant to nitrofurantoin (P ≤ 0.0001); however, the frequency of multi-drug resistant organisms isolated from the urine was not significantly different. CONCLUSIONS: Long-term prescription of nitrofurantoin may reduce UTIs in veterans with SCI and there is no evidence that it promotes multi-drug resistance. Future prospective studies should be conducted prior to incorporating routine use of long-term nitrofurantoin into clinical care.
CONTEXT/ OBJECTIVE: To evaluate the impact of long-term nitrofurantoin for UTI prophylaxis in veterans with SCI. DESIGN: Matched pairs study. SETTING: Veterans cared for at VA facilities from 10/1/2012-9/30/2013. PARTICIPANTS: Veterans. INTERVENTIONS: n/a. OUTCOMES MEASURES: UTI, positive urine cultures, resistant cultures. METHODS: Cases receiving long-term nitrofurantoin (≥90 days supply) were matched to controls by facility. Controls were patients who did not receive long-term nitrofurantoin with a history of ≥3 positive urine cultures and at least one diagnosis of UTI or asymptomatic bacteriuria in the previous year. RESULTS: 122 SCI cases were identified and matched to 196 controls. After adjusting for differences in baseline demographic characteristics, UTIs were less frequent in cases (OR = 0.60 [95% CI 0.44-0.72]). Cases had a greater mean number of days between positive urine cultures as compared to controls (<0.0001). Cases were more likely to have isolates resistant to nitrofurantoin (P ≤ 0.0001); however, the frequency of multi-drug resistant organisms isolated from the urine was not significantly different. CONCLUSIONS: Long-term prescription of nitrofurantoin may reduce UTIs in veterans with SCI and there is no evidence that it promotes multi-drug resistance. Future prospective studies should be conducted prior to incorporating routine use of long-term nitrofurantoin into clinical care.
Authors: M Bethel; F M Weaver; L Bailey; S Miskevics; J N Svircev; S P Burns; H Hoenig; K Lyles; L D Carbone Journal: Osteoporos Int Date: 2016-05-26 Impact factor: 4.507
Authors: James A Karlowsky; Laurie J Kelly; Clyde Thornsberry; Mark E Jones; Daniel F Sahm Journal: Antimicrob Agents Chemother Date: 2002-08 Impact factor: 5.191
Authors: Charlesnika T Evans; Thea J Rogers; Amy Chin; Stuart Johnson; Bridget Smith; Frances M Weaver; Stephen P Burns Journal: J Spinal Cord Med Date: 2013-09 Impact factor: 1.985
Authors: Felicia Skelton-Dudley; James Doan; Katie Suda; S Ann Holmes; Charlesnika Evans; Barbara Trautner Journal: Top Spinal Cord Inj Rehabil Date: 2019