Identifying Optimal Antibiotic Regimens to Treat Urinary Tract Infections During Pregnancy

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PROJECT SUMMARY Urinary tract infections (UTIs) are common in pregnancy and can have serious consequences including pregnancy loss and preterm birth. Minoritized racial and ethnic groups may have higher rates of UTI in pregnancy, but prior studies had important limitations. While some evidence suggests there are racial and ethnic disparities in diagnosis and treatment of other infections, little is known about potential disparities in UTI treatment in pregnancy. This Diversity Supplement would support Ms. Sandra McAteer, a talented master's student in Epidemiology at the University of Washington, to conduct relevant research and gain skills and experience needed for a successful career as a program manager leading interventions to improve the health of women and children. Ms. McAteer's primary mentor will be Dr. Sascha Dublin of Kaiser Permanente Washington, Co-Investigator on the Parent R01 grant. Dr. Anjum Hajat of the University of Washington will be co-mentor, bringing expertise in health disparities research. The Parent R01 aims to generate needed evidence about the comparative safety and effectiveness of antibiotics in pregnancy by analyzing administrative claims and electronic health records data. The Specific Aims of the Parent R01 are: 1) to characterize real-world prescribing patterns, concordance with existing guidelines, and antimicrobial susceptibility patterns relevant to the outpatient treatment of UTIs in pregnancy; 2) to compare the risk of treatment failure with commonly-used antibiotic regimens; and 2) to evaluate the comparative safety of these antibiotic regimens with respect to birth defects and perinatal complications. The Parent R01 does not include a health equity focus, and specifically, it does not examine whether there are differences in UTI incidence or treatment or in the prevalence of antimicrobial resistance by race or ethnicity. Specific Aims of the proposed Diversity Supplement Research are to characterize differences in the incidence and treatment of UTI in pregnancy by patient race and ethnicity, including differences in choice of antibiotic and concordance of treatment with clinical guidelines. For an exploratory aim, Ms. McAteer will examine differences in antimicrobial resistance by race and ethnicity. Ms. McAteer's Career Development and Research Plan will include coursework, directed readings, participation in seminars and conferences, and conducting research supported by a multidisciplinary group of mentors. These activities will help her build the scientific and professional skills for a successful career as a program manager leading interventions to improve the health of women and children from underrepresented groups. Impact: The proposed Diversity Supplement will augment the Parent R01 by adding a health equity focus and increasing knowledge about differences in incidence and treatment of UTIs by race and ethnicity. Results could be used to develop targeted interventions to improve care for UTIs in pregnancy and ultimately to improve health outcomes for pregnant people and infants.