When Empiric Therapy Fails: Clinical and Economic Consequences in uUTIs Among US Women

Uncomplicated urinary tract infection (uUTI) management is increasingly challenging due to antibiotic treatment failure (TF). This retrospective, observational cohort study used Optum’s de-identified Electronic Health Record dataset (January 2017–September 2022) to investigate the impact of antibiotic TF (defined as a second oral antibiotic prescription, administration of an intravenous antibiotic, or an emergency department visit/hospitalization with a new primary diagnosis of urinary tract infection <28 days post index) on clinical outcomes and healthcare resource utilization (HCRU) among women with uUTI. Eligible patients were female, aged ≥12 years, with an outpatient diagnosis of uUTI and one or more empirically prescribed oral antibiotics within ±5 days of diagnosis (index). Adjusted risk ratios (aRR) of adverse clinical outcomes were assessed ≤12 months post index (observation period), and rate ratios of all-cause and UTI-related HCRU during the index episode and observation period were observed. Of 376,004 patients, 62,873 (16.7%) experienced TF, while 313,131 (83.3%) did not. Patients with TF had significantly higher risk (aRR [95% CI]) of recurrent UTI (1.23 [1.21, 1.25]) and acute pyelonephritis (1.77 [1.70, 1.84]) (both p < 0.001) versus those without. Patients with TF had significantly greater all-cause and UTI-related HCRU versus patients without. Overall, patients with TF had significantly higher risk of adverse outcomes and greater HCRU than patients without TF.