Urinary tract infections

Urinary tract infections and recurrent urinary tract infections pose significant burdens on patients and healthcare systems. Testing and treatment strategies are increasingly important in the age of antibiotic resistance and stewardship. 

 We designed a decision tree to model four strategies (Figure 1) for managing UTIs: (1) empirical antibiotics first, followed by culture-directed antibiotics if symptoms persist; (2) urine culture first, followed by culture-directed antibiotics; (3) urine culture at the same time as empirical antibiotics, followed by culture-directed antibiotics if symptoms persist; (4) symptomatic treatment first, followed by culture-directed antibiotics if symptoms persist. To model both patient and society-level concerns, we built three versions of this model with different outcome measures: quality-adjusted life-years (QALY), symptom-free days, and antibiotic courses given. Societal cost of antibiotic resistance was modeled for each course of antibiotics given. The probability of UTI and the level of antibiotic resistance were modeled from 0-100%. We also extended the model to account for patients requiring catheterization for urine specimen collection.

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