(A-139) Recurrent Urinary Tract Infections and Long-Term Antibiotic Use During Pregnancy in Publicly and Commercially Insured US Populations

Background: Recurrent urinary tract infections (UTIs) in pregnancy pose a significant clinical challenge. Although guidelines recommend long-term suppressive therapy with nitrofurantoin or cephalexin, adherence to these recommendations is unclear.

Objectives: To describe the incidence of recurrent UTIs and the use of long-term antibiotic suppression during pregnancy.

Methods: Using US Medicaid (2000–18, publicly insured) and MarketScan (2003–21, commercially insured) databases, we identified 2 cohorts of pregnant women with live births aged 12–55. They were required to be continuously enrolled from 90 days before the last menstrual period (LMP) to 1 month postpartum, without evidence of bladder/kidney infections or treated UTI in the 90 days before LMP. UTIs were identified based on >=1 related ICD 9/10 diagnosis or procedure codes followed by >=1 UTI-specific antibiotic dispensing (i.e., nitrofurantoin, cephalexin, cefpodoxime, sulfamethoxazole/trimethoprim, fosfomycin, amoxicillin, ampicillin, penicillin) within 7 days. We estimated the proportion of patients with recurrent UTIs, defined as >=2 treated UTIs during pregnancy. Among those with >=3 treated UTIs, where suppression treatment of nitrofurantoin or cephalexin is typically recommended, we assessed the use of long-term antibiotic therapy. Long-term antibiotic therapy was defined as a treatment episode of ≥30 days of nitrofurantoin or cephalexin. If the pregnancy ended before 30 days, long-term therapy was defined as treatment for the remainder of the pregnancy.

Results: Out of 2,522,450 pregnancies in Medicaid and 1,875,849 in MarketScan, we identified 15.4% (Medicaid) and 9.3% (MarketScan) with a single treated UTI, while 5.6% and 2.1% had recurrent UTIs. The incidence of recurrent UTIs remained stable over time in both populations. Among pregnancies with recurrent UTIs, 30.2% (Medicaid) and 25.7% (MarketScan) experienced >=3 UTIs during pregnancy. Among them, 12.4% (Medicaid) and 20.2% (Marketscan) had long-term suppressive therapy. Nitrofurantoin was more commonly prescribed than cephalexin in both populations (Medicaid: 9.23% vs 3.58%), and (Marketscan: 15.52% vs 5.51%).

Conclusions: In the US, the incidence of treated UTIs, and in particular recurrent UTIs is higher among publicly insured than among commercially insured populations. Despite guideline recommendations, long-term antibiotic therapy for recurrent UTIs in pregnancy was infrequently prescribed in both study cohorts. Further research is needed to understand the barriers to optimal management of recurrent UTIs during pregnancy and the clinical impact of underutilized suppressive therapy.