Long-term prescribing of nitrofurantoin for urinary tract infections (UTI) in veterans with spinal cord injury (SCI)

Abstract

Context/Objective

To evaluate the impact of long-term nitrofurantoin for UTI prophylaxis in veterans with SCI.

Design

Matched pairs study.

Setting

Veterans cared for at VA facilities from 10/1/2012-9/30/2013.

Participants

Veterans.

Interventions

n/a.

Outcomes measures

UTI, positive urine cultures, resistant cultures.

Methods

Cases receiving long-term nitrofurantoin (≥90 days supply) were matched to controls by facility. Controls were patients who did not receive long-term nitrofurantoin with a history of ≥3 positive urine cultures and at least one diagnosis of UTI or asymptomatic bacteriuria in the previous year.

Results

122 SCI cases were identified and matched to 196 controls. After adjusting for differences in baseline demographic characteristics, UTIs were less frequent in cases (OR = 0.60 [95% CI 0.44-0.72]). Cases had a greater mean number of days between positive urine cultures as compared to controls (<0.0001). Cases were more likely to have isolates resistant to nitrofurantoin (P ≤ 0.0001); however, the frequency of multi-drug resistant organisms isolated from the urine was not significantly different.

Conclusions

Long-term prescription of nitrofurantoin may reduce UTIs in veterans with SCI and there is no evidence that it promotes multi-drug resistance. Future prospective studies should be conducted prior to incorporating routine use of long-term nitrofurantoin into clinical care.

Keywords:

• Nitrofurantoin
• Spinal cord injuries
• Urinary tract infections
• Antibiotic prophylaxis
• Outcome assessment
• Practice patterns
• Physicians

Acknowledgements

The authors wish to thank Dr. Beverly Gonzalez for statistical expertise and manuscript review. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs of the United States government.

Disclaimer statements

Contributors None.

Conflicts of interest The authors have no conflicts of interest to declare.

Ethics approval None.

Additional information

Funding

This work was supported by Veterans Health Administration, Office of Research and Development, Rehabilitation Research and Development Service SPIRE Award (B-1583-P), and Health Services Research and Development Service Post-Doctoral Fellowship Award (TPR 42-005).