SUFU 2022: Bladder Hotline: The Impact of COVID-19 and Telemedicine on Empiric UTI Treatment in Women

( The effects of the COVID-19 pandemic and telemedicine on urinary tract infection (UTI) treatment are largely unknown. This study evaluated the impact of COVID-19 and telemedicine on empiric UTI treatment in women, hypothesizing that increased use of telemedicine during the pandemic would increase the rate of empiric UTI treatment.

This was a retrospective cohort study of treatment patterns of female patients aged 18-65. The authors queried ICD-10 codes for acute cystitis without hematuria (N30.00) and with hematuria (N30.01) during the first 6 months of the pandemic (March 2020 – August 2020) versus the 6 months preceding the pandemic (September 2019 – February 2020). The primary outcome was the presence of empiric antibiotic treatment, defined by treatment based on clinical picture with or without pending urine testing. Secondary analysis included determining which antibiotics were most commonly prescribed and treatment adjustment following the initial encounter. Exclusion criteria included inpatient encounter, long-term care facility residence, urinary procedure in last 2 weeks, previously treated for UTI within 30 days.

The average age of participants was 42 years, 52% 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% during the pandemic (p=.055). The rate of treatment based on clinical picture with no pending urine testing was significantly higher during the pandemic versus pre-pandemic (p<.0001).

Nitrofurantoin or trimethoprim/sulfamethoxazole was prescribed in 79%. The overall rate of treatment adjustment was 17.1%, and there was no significant difference pre-pandemic compared to during the pandemic.

The authors concluded that Covid-19 dramatically increased telemedicine utilization by women with UTI symptoms. Empiric treatment for UTI approached significance and confirmatory urine testing was done significantly less during the pandemic. There is a need to further characterize and monitor telemedicine’s impact on UTI treatment.

Presented by: Madeline J. Epsten, Jennifer Ferraro, Fareesa Khan, Cynthia Brincat, Kristin M. Jacobs

Written by: Diane K. Newman, DNP, ANP-BC, FAAN, Adjunct Professor of Urology in Surgery, Perelman School of Medicine, University of Pennsylvania and Co-Director of the Penn Center for Continence and Pelvic Health at the 2022 Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU) Winter Meeting, February 22 - 26, 2022