1435. Unmet Needs in Uncomplicated Urinary Tract Infection in the United States and Germany: A Physician Survey
Authors: O’Brien Megan , Marijam Alen , Mitrani-Gold Fanny S , Terry Laura , Taylor-Stokes Gavin , Pike James , Joshi Ashish V 
Published: December 2021

Abstract

Background
Uncomplicated urinary tract infections (uUTI) are one of the most common bacterial infections in women. Understanding unmet needs of physicians in diverse healthcare systems is important for developing novel uUTI treatment (tx).

Methods
A cross-sectional survey of physicians in the US and Germany (DE). Physicians were recruited via specialist panel and the survey was piloted (1 US, 1 DE physician) prior to recruitment. Primary objectives were understanding physician tx goals, management approaches, and prescribing patterns for uUTI. Secondary objectives included understanding perceptions of uUTI impact on patients and awareness of antibiotic (AB) resistance. Descriptive statistics were used for analysis. See Table for inclusion/exclusion criteria.
Table. Physician inclusion and exclusion criteria

Results
Overall, 300 physicians (200 US, 100 DE) were surveyed. Symptom relief was in the top 3 (of 5) most important outcomes for ≥ 90% of physicians (US and DE); clearing infection was a top 3 outcome for 85% of US and 60% of DE physicians (Fig. 1). Physicians estimated ~20% of patients do not achieve complete relief from initial AB tx. Generally, urinalysis, dip stick, and symptom review were most commonly used in diagnosis, with culture and AB susceptibility tests mostly used to aid tx decisions (Fig. 2). For first-line AB, US physicians reported trimethoprim-sulfamethoxazole (TMP-SMX; 76%) and nitrofurantoin (57%) as most prescribed; in DE, fosfomycin (61%) and TMP-SMX (50%) were prescribed most. In both countries, ciprofloxacin (US 51%, DE 45%) was most prescribed after ≥ 2 tx failures. On a scale of “very poor” (1) to “exceptional” (7) for tx and management of uUTI, 58% of US physicians gave TMP-SMX a 6 or 7, and 62% of DE physicians gave fosfomycin a 6 or 7. More than 33% of physicians believed patients’ quality of life was greatly impacted by 1 tx failure, rising to 60% of physicians for 2 tx failures, and 73% for ≥ 3. Most physicians (72% US, 83% DE) agreed that development of AB resistance was serious (Fig. 3), but fewer (56% US, 46% DE) were confident in their knowledge of AB resistance.
Figure 1. Treatment goal considered in the top 3 most important goals by physicians for managing patients with uUTI

Figure 2. Use of diagnosis (A) and treatment decision (B) aids

Figure 3. Physicians’ opinions on antibiotic resistance

Conclusion
Symptom relief was the primary uUTI tx goal for physicians. Physicians recognized that patients are greatly impacted by tx failure and AB resistance is a serious problem, but many were not confident or had insufficient information on AB resistance.

Disclosures
Megan O’Brien, BA, Adelphi Real World (Employee, Employee of Adelphi Real World, which received funding from GlaxoSmithKline plc. to conduct this study) Alen Marijam, MSc, GlaxoSmithKline plc. (Employee, Shareholder) Fanny S. Mitrani-Gold, MPH, GlaxoSmithKline plc. (Employee, Shareholder) Laura Terry, MSc, Adelphi Real World (Employee, Employee of Adelphi Real World, which received funding from GlaxoSmithKline plc. to conduct this study) Gavin Taylor-Stokes, MBA, Adelphi Real World (Employee, Employee of Adelphi Real World, which received funding from GlaxoSmithKline plc. to conduct this study) James Pike, B.Sc. Hons., M.Phil., Adelphi Real World (Employee, Employee of Adelphi Real World, which received funding from GlaxoSmithKline plc. to conduct this study) Ashish V. Joshi, PhD, GlaxoSmithKline plc. (Employee, Shareholder)