Is SGLT-2 Inhibitor Use Connected with the Incidence and Different Management of Lower Urinary Tract Infections in Family Medicine: A Retrospective Study

Background and Objectives: Sodium-glucose cotransporter type 2 (SGLT-2) inhibitors provide substantial cardiovascular and renal benefits, but concerns regarding urinary tract infections (UTIs) may limit their use. This study aimed to evaluate the incidence and management of lower UTIs among patients receiving SGLT-2 inhibitors compared to other patients and to identify associated risk factors in primary care. Materials and Methods: This retrospective observational study included 5764 adults from four family medicine practices from November 2024 to October 2025. Patients were categorized according to lower UTI occurrence, complexity, and SGLT-2 inhibitor use. Demographic characteristics, comorbidities, laboratory parameters, treatment duration, urine cultures, and antibiotic therapy were analyzed. Results: Lower UTIs occurred in 567 patients (9.8%), of whom 30 (16.3%) were taking SGLT-2 inhibitors, and were more frequent among women and patients with diabetes, chronic kidney disease (CKD), benign prostatic hyperplasia (BPH), urolithiasis, and permanent urinary catheters. Except for urolithiasis, all these factors were also independent predictors of lower UTI development in the logistic regression model. In contrast, patients taking an SGLT-2 inhibitor had 43.8% lower odds of developing a UTI, though this may reflect temporal relationship bias. SGLT-2 inhibitors were prescribed to 24.2% of patients with type 2 diabetes, while their use for CKD and heart failure was limited. Family physicians managed 90% of uncomplicated and 64% of complicated lower UTIs. Urine cultures were performed in less than one-third of these patients. Nitrofurantoin was prescribed as the first-choice antibiotic regardless of UTI complexity, predominantly by family physicians. Hospital specialists more often choose fluoroquinolones, followed by cephalosporins. Conclusions: Despite increased lower UTI incidence among patients receiving SGLT-2 inhibitors, their use was not associated with lower UTI development. Urine cultures were insufficiently utilized in patients with UTIs, and they were predominantly not treated according to the latest guidelines. SGLT-2 inhibitors were also underused, particularly for CKD and heart failure, suggesting a potential gap between recommendations and clinical practice.