Studies of urinary tract infection (UTI) treatment in telehealth settings have primarily evaluated young, healthy females. Urine culture collection is less common in telehealth settings but is recommended for all patients with potentially complicated infection. The aims of this study were: (1) to compare UTI-related clinical failure between telehealth and in-person primary care settings, and (2) evaluate if urine culture (UC) collection impacted UTI-related failure in patients with risk for antibiotic resistant infection. A retrospective cohort study of outpatients diagnosed with UTI between 2019 and 2021 in the Department of Veterans Affairs system was conducted. Inclusion required a telehealth or primary care visit with UTI International Classification of Diseases-Clinical Modification 10th revision code documentation and an antibiotic dispensed. Patients with recent UTI, concurrent indications for antibiotics, or where asymptomatic bacteriuria treatment was appropriate were excluded. Treatment failure was defined as combination of a new UTI-related outpatient visit or hospitalization that occurred between 3 to 30 days after the antibiotic dispense date. Antibiotic exposure data, covariates, hospitalization, and UC history were obtained. Overlap weighting and generalized estimating equation models estimated the relative risk of failure for clinical setting and for UC collection versus no collection. There were 16,266 telehealth and 29,296 primary care patient-visits evaluated. The adjusted relative risk (±95% CI) of failure for telehealth relative to primary care was [0.87 (0.70, 1.08)]. An interaction between setting and age ≥65 [1.45 (1.12, 1.87)] indicated higher failure for elderly patients treated for UTI in telehealth. Urine culture collection was associated with increased risk of failure for patients treated in telehealth [2.06 (1.56, 2.72)]; however, an interaction between UC collection and prior antibiotic exposure ≤90 days indicated a protective effect in both telehealth [0.70 (0.53, 0.93)] and primary care [0.77 (0.60, 0.99)] settings. Overall, no difference in the clinical failure rate for UTI treatment between telehealth and primary care was observed. However, elderly patients treated for UTI in telehealth experienced higher failure relative to in-person primary care. Patients with recent prior antibiotic exposure in both settings had lower clinical failure rates when UCs were collected.

Background/Objectives: Advanced wound healing biologics for diabetic foot ulcer (DFU) are typically withheld from persons who are at high risk for amputation. However, a prospective, single-center cohort study evaluated the use of an advanced biologic, dehydrated amniotic (DAMA) tissue as early treatment for DFUs in patients with a high risk for amputation, demonstrating benefit for a small sample. This is the report of the five-year follow-up of those high-risk participants. Methods: This chart review provides a 5-year follow-up of 18 of 20 participants in the original study. The data were collected by medical record review. Specific data points included mortality, re-ulceration and additional ulceration, amputation (minor and major), end-stage renal disease with dialysis dependence, hospitalization, and limb-threatening ischemia. Results: The 5-year mortality rate from the time of wound healing was 50% (9/18 deceased). Four of the eighteen participants (22.2%) underwent major amputation within 5 years of study completion. Two had amputations of the study limb and two had amputations of the contralateral limb. Fifty percent (2/4) of those who had amputations died within 5 years after the major amputation. Over fifty percent (55.5% or 10 out of 18) of the participants experienced the re-ulceration of the original study ulcer and 94% (17 out of 18) developed a new site ulceration. A total of 25% of the hospitalizations over the 5 years were related to DFU (infection, osteomyelitis, and sepsis). Conclusions: This small-sample 5-year follow-up shows that early treatment with dehydrated amniotic (DAMA) tissue in patients with diabetic foot ulcers of moderate-to-high amputation risk results in similar outcomes as noted in the current research on patients with low risk for amputation. In fact, this paper may suggest that advanced biologics can safely be used for early treatment in moderate-to-high amputation risk without increasing mortality and amputation over 5 years.