Antibiotic prescribing for urinary tract infections in women residing in long-term care: A retrospective cohort study

Introduction: This study describes all antibiotics dispensed to long-term care (LTC)-dwelling women with a suspected or confirmed uncomplicated urinary tract infection (UTI) in health administrative data. The outcomes of ambulatory visits, hospitalizations, and dispensation of additional antibiotics were compared for those dispensed fluoroquinolones (FQs) and those dispensed other antibiotics. Methods: This retrospective cohort study assessed administrative health data collected between January 2005 and March 2020 in Nova Scotia, Canada. Women aged 65 years or older who resided in LTC, identified with ICD 9 or 10 codes that represented an uncomplicated UTI and had an antibiotic dispensation within 5 days of the identified UTI code, were included. Antibiotic dispensations were reported descriptively and a Mann-Kendall test was used to assess change over time. A logistic regression model estimated the odds ratios for FQ compared to non-FQ recipients for all outcome events. Results: There were 15,276 uncomplicated UTI events reported in 7,078 women. UTI events decreased significantly over time (1,387 in 2005 to 402 in 2019 [p < 0.001]). The most dispensed antibiotics were trimethoprim-sulfamethoxazole (25.8%), nitrofurantoin (25.5%), and ciprofloxacin (18.6 %). Compared to all other antibiotics, FQ dispensation was not associated with any difference in need for hospitalization. There was a reduced risk of subsequent antibiotic dispensation and follow-up ambulatory care visits for those dispensed FQs in the adjusted analysis. Conclusions: A decline in antibiotic dispensations associated with uncomplicated UTI events was observed over the 15-year period. The findings support guideline recommendations to limit FQ prescribing for uncomplicated UTI, as few differences for the outcomes investigated were identified.