The role of race and ethnicity in Antibiotic Prescribing practices for Inpatient Urinary Tract Infection cases Open Access

Abstract

Background

This study aimed to examine the use of anti-pseudomonal antibiotics among a diverse inpatient population to identify potential biases in prescribing practices for urinary tract infection (UTI) patients. Despite growing evidence of disparities in outpatient care, the relationship between race, ethnicity, and inpatient antibiotic prescribing remains unclear.

Methods

This retrospective observational cohort study utilized electronic medical record (EMR) data from patients admitted to hospital medicine services across four Emory University hospitals between January 1, 2019, and June 30, 2022. Patients included were aged 18 or older, received at least one antibiotic during hospitalization, and had a discharge diagnosis of UTI or urosepsis (based on ICD-10-CM codes). Baseline characteristics were assessed using univariate logistic regression stratified by race. Multivariate logistic regression with backward selection (p < 0.05 for retention) identified predictors of antibiotic prescribing patterns, focusing on anti-pseudomonal antibiotic use.

Results          

The study analyzed 7,283 unique inpatient encounters. After adjusting for independent predictors, race remained a borderline significant factor in predicting receipt of any days of therapy with anti-pseudomonal antibiotics. Compared to Non-Hispanic White patients, adjusted odds ratios were 0.89 (95% CI: 0.79–1.01) for Non-Hispanic Black individuals, 1.31 (95% CI: 0.91–1.86) for Hispanic or Latino individuals, and 1.12 (95% CI: 0.86–1.46) for individuals identifying with other racial or ethnic groups.

Conclusion

Key findings reveal variations in anti-pseudomonal antibiotic prescribing for inpatient UTI patients across racial and ethnic groups, aligning with prior research and highlighting potential disparities in medical treatment, While these differences did not reach statistical significance, the observed trends warrant further investigation to confirm their validity and assess their clinical relevance in the context of healthcare equity.²¹²²

Table of Contents

Table of Contents

Introduction. 8

Methods. 9

Study Design: 9

Study Population: 10

Variables of interest: 10

Data Analysis: 11

Results: 11

Discussion: 13

Conclusion and public health implications: 14

Tables and Figures. 15

References: 25

About this Master's Thesis

Rights statement

• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Epidemiology - MPH & MSPH
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Epidemiology Health Sciences, Health Care Management
Keyword	Urinary Tract Infection Antibiotic prescribing stewardship Anti-pseudomonal Disparities Antimicrobial Biases
Committee Chair / Thesis Advisor	Scott Fridkin, Emory University

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