Does unnecessary treatment of suspected urinary tract infection in the emergency department vary by area deprivation index?

Emerging evidence suggests a link between socioeconomic disadvantage and increased antibiotic use, which may drive antibiotic resistance. We evaluated the association between Area Deprivation Index (ADI) and unnecessary antibiotic prescribing practices for suspected urinary tract infections (UTIs) in an emergency department setting. We conducted a retrospective cross-sectional study of patients discharged with antibiotic prescriptions for suspected UTIs from the Veterans Affairs Connecticut Healthcare System emergency department between September 2020, and August 2021. Two infectious disease physicians reviewed records for demographics, comorbidities, clinical signs, and urine culture results. Unnecessary treatments were defined by the absence of pyuria on urinalysis and clinical criteria. Bivariate analyses used Kruskal-Wallis and Fisher’s exact tests. Multivariable logistic regression assessed the ADI’s association with unnecessary antibiotic use. Of 174 patients with suspected UTIs were included, the mean age was 69 years, with 29% receiving unnecessary treatment. No significant difference was noted concerning unnecessary treatment and ADI (p = 0.32). Unnecessary antibiotic prescriptions for UTIs were prevalent in emergency settings. Understanding the factors contributing to these disparities is essential for improving antibiotic stewardship and addressing health inequities.