Bladder HOTline: The Impact of COVID-19 and Telemedicine on Empiric Urinary Tract Infection Treatment in Women

ABSTRACT

INTRODUCTION: Urinary tract infection (UTI) is responsible for 15% of all community-prescribed antibiotics. The effects of the pandemic on UTI treatment are largely unknown. We evaluated the impact of COVID-19 and telemedicine on empiric UTI treatment in women, hypothesizing that increased telemedicine during the pandemic would increase empiric UTI treatment. METHODS: This is a retrospective cohort study of treatment patterns of female patients aged 18-65 using ICD-10 codes for acute cystitis with and without hematuria during the first 6 months of the pandemic versus the preceding 6 months. Our primary outcome was empiric antibiotic treatment, defined by treatment based on clinical picture with/without pending urine testing. To reach 80% power, we included 222 patients. RESULTS: The average age of participants was 42. Fifty-two percent were White, 23% Black, and 23% Hispanic. No demographic differences existed between cohorts. During the pandemic, 36.6% of UTI encounters were conducted via telemedicine, compared to 1.5% pre-pandemic (P<.0001). The rate of empiric treatment increased from 58.2% pre-pandemic to 70.5% pandemic (P=.055). The rate of treatment based on clinical picture with no pending urine testing was significantly higher during the pandemic (P<.0001). Nitrofurantoin or trimethoprim/sulfamethoxazole was used in 79% of patients prescribed an antibiotic. The treatment adjustment rate was 17.1%. CONCLUSION: COVID-19 dramatically increased telemedicine utilization by women with UTI symptoms. Empiric treatment approached significance and confirmatory urine testing was done significantly less during the pandemic. Given the importance of antibiotic stewardship, it is important to further characterize telemedicine's impact on treatment of this common condition.