(P-500) Impact of Chronic Diseases on the Adherence to Guidelines for the Treatment of Urinary Tract Infection in Quebec, Canada

Background: With the rising threat to world health caused by antimicrobial resistance, previously simple infections, such as urinary tract infections (UTIs), now require much more minutiae. This is especially true in chronically ill patients, who on average are more exposed to resistant microorganisms through the healthcare system and consume more antibiotics than non chronically ill patients.

Objectives: Provide a descriptive overview of community antimicrobial use for treatment of UTIs in Quebec from 2002 to 2016, in relation to the presence of chronic diseases and determine if their presence influenced clinicians’ tendencies to adhere to clinical guidelines.

Methods: We performed a population-based longitudinal study from 2002 to 2016 using the Quebec Integrated Chronic disease surveillance system, an administrative database. We identified adult patients receiving prescriptions for UTIs. Concordance to clinical guidelines was determined based on the antibiotic served and the quantity served. Two multivariate models using robust Poisson regression were used to determine if the number and the type of chronic diseases influenced clinicians’ adherence to guidelines from 2013 to 2016.

Results: A total of 1 258 211 prescriptions were analysed. Guideline adherence for our study period was 32%, progressing from 24% in 2002 to 43% in 2016. Multivariate models showed a cumulative effect of chronic diseases on guideline adherence. Compared to patients with no chronic disease, the risk of receiving a non-concordant prescription increased from 1.02 (95%CI:1.01-1.03) with one chronic disease to 1.12 (1.11-1.13) with four or more. The type of chronic diseases also had an impact on guideline adherence, ranging from a relative risk of 1.02 (95% CI: 1.01-1.03) (respiratory disease) to 1.04 (95% CI: 1.03-1.05) (diabetes).

Conclusions: Our analysis showed suboptimal antibiotic prescription for treatment of UTIs, especially among multimorbid individuals. The choice of antibiotic almost always matched guidelines, however, quantities served were often higher than recommended. The reasons behind these deviations must be explored, as proper antibiotic use is extremely important for public health and for preventing antimicrobial resistance.