2825. Clinician Treatment Considerations and Decisions in Hypothetical Uncomplicated Urinary Tract Infection Patient Vignettes
Authors: Ellis Jeffrey J , Moore Kristin J , Bui Bonnie H K , Friderici Jennifer , Carlyle Maureen , Martin Carolyn K , Webb Noah S , Luck Megan E , Proco Darrian , Kahle-Wrobleski Kristin 
Published: November 2023

Abstract

Background
For uUTI, Infectious Diseases Society of America (IDSA) guidelines recommend empiric treatment (Tx) based on clinical presentation and patient (pt) factors (including age, allergies, drug resistance, recurrence history). This study aimed to understand the decision-
making process among clinicians treating pts with uUTI.

Methods
US clinicians treating pts with uUTI completed an online cross-sectional survey collecting diagnosis and Tx decision-making information. Inclusion criteria were self-reported: currently practicing, having seen ≥1 uUTI pt(s) in the past month and ≥12 uUTI pts in the past year, with 2–25 years’ experience post-training. Survey items included clinician/practice characteristics and pt vignettes. Survey items probing diagnosis and Tx decision-making followed each vignette. Analyses were descriptive.

Results
206 clinicians completed the survey (49% physicians, 33% nurse practitioners, 18% physician assistants); 71% practiced in primary care (Table 1). The proportion of clinicians who reported that their practice maintains guidelines for uUTI diagnosis and Tx was, respectively: for an initial uUTI, 32.5% and 45.6%; for recurrent/persistent uUTI, 38.8% and 39.8%. Pt experience with other therapies was selected by 52.9% of respondents as the most important characteristic in Tx selection; meanwhile, pregnancy (88.4%), allergies (84.0%) and prior compliance (78.6%) were frequently reported factors considered when making prescribing decisions. For vignette-specific Tx decisions, NTF and SXT were the predominant initial Tx selections; 86–97% of respondents reported they took antimicrobial resistance into consideration (Table 2). Though infrequent, Tx selection incongruent with IDSA guidelines was
observed, e.g., selection of same antibiotic that failed to resolve uUTI (vignettes 3 and 6). Clinical presentation and uUTI history were the highest ranked vignette-specific factors important to Tx decisions (Figure).

Conclusion
Vignette Tx decisions did not always align with IDSA guidelines. Future work should compare decision-making processes of physicians and other clinicians and assess the impact of barriers to appropriate Tx selection, such as the absence of practice-maintained guidelines.

Disclosures
Jeffrey J. Ellis, PharmD, MS, GSK: Jeffrey J. Ellis is an employee of, and shareholder in, GSK Kristin J. Moore, PhD, MPH, Optum: Kristin J. Moore is an employee of Optum, which received funding from GSK to conduct this study Bonnie H.K. Bui, PhD, Optum: Bonnie H.K. Bui is an employee of Optum, which received funding from GSK to conduct this study Jennifer Friderici, MS, Optum: Jennifer Friderici is an employee of Optum, which received funding from GSK to conduct this study Maureen Carlyle, MPH, Optum: Maureen Carlyle is an employee of Optum, which received funding from GSK to conduct this study Carolyn K. Martin, MSW, Optum: Carolyn K. Martin is an employee of Optum, which received funding from GSK to conduct this study Noah S. Webb, PhD, Optum: Noah S. Webb is an employee of Optum, which received funding from GSK to conduct this study Megan E. Luck, PharmD, GSK: Employee of, and shareholder in GSK Darrian Proco, PharmD, GSK: Darrian Proco is an employee of, and shareholder in, GSK Kristin Kahle-Wrobleski, PhD, GSK: Kristin Kahle-Wrobleski is an employee of, and shareholder in, GSK