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Examining antibiotic prescribing and urine culture testing for urinary tract infections (UTIs) in a primary care spinal cord injury (SCI) cohort

Spinal Cord volume 61, pages 345–351 (2023)Cite this article

Subjects

Abstract

Study design

A retrospective cohort study.

Objectives

To describe antibiotic prescribing and urine culture testing patterns for urinary tract infections (UTIs) in a primary care Spinal Cord Injury (SCI) cohort.

Setting

A primary care electronic medical records (EMR) database in Ontario.

Methods

Using linked EMR health administrative databases to identify urine culture and antibiotic prescriptions ordered in primary care for 432 individuals with SCI from January 1, 2013 to December 31, 2015. Descriptive statistics were conducted to describe the SCI cohort, and physicians. Regression analyses were conducted to determine patient and physician factors associated with conducting a urine culture and class of antibiotic prescription.

Results

The average annual number of antibiotic prescriptions for UTI for the SCI cohort during study period was 1.9. Urine cultures were conducted for 58.1% of antibiotic prescriptions. Fluroquinolones and nitrofurantoin were the most frequently prescribed antibiotics. Male physicians and international medical graduates were more likely to prescribe fluroquinolones than nitrofurantoin for UTIs. Early-career physicians were more likely to order a urine culture when prescribing an antibiotic. No patient characteristics were associated with obtaining a urine culture or antibiotic class prescription.

Conclusion

Nearly 60% of antibiotic prescriptions for UTIs in the SCI population were associated with a urine culture. Only physician characteristics, not patient characteristics, were associated with whether or not a urine culture was conducted, and the class of antibiotic prescribed. Future research should aim to further understand physician factors with antibiotic prescribing and urine culture testing for UTIs in the SCI population.

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Fig. 1: Characteristics associated with prescribing antibiotic class and conducting urine culture.

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Data availability

The dataset from this study is held securely in coded form at ICES. While legal data sharing agreements between ICES and data providers prohibit ICES from making the dataset publicly available, access may be granted to those who meet pre-specified criteria for confidential access, available at www.ices.on.ca/DAS (email: das@ices.on.ca). The full dataset creation plan and underlying analytic code are available from the authors upon request, understanding that the computer programs may rely upon coding templates or macros that are unique to ICES and are therefore either inaccessible or may require modification.

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Acknowledgements

This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health (MOH) and the Ministry of Long-Term Care (MLTC). This document used data adapted from the Statistics Canada Postal CodeOM Conversion File, which is based on data licensed from Canada Post Corporation, and/or data adapted from the Ontario Ministry of Health Postal Code Conversion File, which contains data copied under license from ©Canada Post Corporation and Statistics Canada. Parts of this material are based on data and/or information compiled and provided by CIHI and the Ontario Ministry of Health. The analyses, conclusions, opinions and statements expressed herein are solely those of the authors and do not reflect those of the funding or data sources; no endorsement is intended or should be inferred. Thank you to Jun Guan, Zhiyin Li, and staff at ICES for their contributions to this paper.

Author information

Authors and Affiliations

  1. Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada

    Arrani Senthinathan & Susan B. Jaglal

  2. KITE (Knowledge Innovation Talent Everywhere), Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada

    Arrani Senthinathan & B. Catherine Craven

  3. Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada

    B. Catherine Craven

  4. Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute – University Health Network, Toronto, ON, Canada

    B. Catherine Craven

  5. Antimicrobial Stewardship Program, University Health Network, Toronto, ON, Canada

    Andrew M. Morris

  6. Department of Medicine, Division of Infectious Diseases, Sinai Health, University Health Network, and University of Toronto, Toronto, ON, Canada

    Andrew M. Morris

  7. Bloorview Research Institute / Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada

    Melanie Penner

  8. Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada

    Melanie Penner

  9. Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada

    Karen Tu

  10. North York General Hospital, Toronto, ON, Canada

    Karen Tu

  11. Toronto Western Family Health Team, University Health Network, Toronto, ON, Canada

    Karen Tu

  12. Rehabilitation Science Institute and Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada

    Susan B. Jaglal

  13. ICES, Toronto, ON, Canada

    Susan B. Jaglal

Authors
  1. Arrani Senthinathan
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  4. Melanie Penner
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  5. Karen Tu
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  6. Susan B. Jaglal
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Contributions

All authors contributed to the development of this paper, its study design and interpretation of results. AS conceptualized the study, analyzed the data, interpreted results, and wrote the manuscript. SBJ guided the data analyses and development of manuscript. SBJ, KT, MP, AMM, and BCC helped with the overall interpretation of findings, and reviewed the manuscript.

Corresponding author

Correspondence to Arrani Senthinathan.

Ethics declarations

Competing interests

The authors declare no competing interests.

Ethics approval

The use of data in this project was authorized under section 45 of Ontario’s Personal Health Information Protection Act, which does not require further review by a Research Ethics Board. The use of the data in this project is authorized under section 45 and approved by ICES’ Privacy and Legal Office.

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Senthinathan, A., Craven, B.C., Morris, A.M. et al. Examining antibiotic prescribing and urine culture testing for urinary tract infections (UTIs) in a primary care spinal cord injury (SCI) cohort. Spinal Cord 61, 345–351 (2023). https://doi.org/10.1038/s41393-023-00899-x

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