Variations in presentation, management, and patient outcomes of urinary tract infection : a prospective four-country primary care observational cohort study
Butler, Christopher C.; Francis, Nick A.; Thomas-Jones, Emma; Llor, Carl; Bongard, Emily; Moore, Michael; Little, Paul; Bates, Janine; Lau, Mandy; Pickles, Timothy; Gal, Micaela; Wootton, Mandy; Kirby, Nigel; Gillespie, David; Rumbsy, Kate; Brugman, Curt; Hood, Kerenza; Verheij, Theo
(2017) British Journal of General Practice, volume 67, issue 665, pp. e830 - e841
(Article)
Abstract
BACKGROUND: Regional variations in the presentation of uncomplicated urinary tract infection (UTI) and pathogen sensitivity to antibiotics have been cited as reasons to justify differences in how the infections are managed, which includes the prescription of broad-spectrum antibiotics. AIM: To describe presentation and management of UTI in primary care settings,
... read more
and explore the association with patient recovery, taking microbiological findings and case mix into account. DESIGN AND SETTING: Prospective observational study of females with symptoms of uncomplicated UTI presenting to primary care networks in England, Wales, the Netherlands, and Spain. METHOD: Clinicians recorded history, symptom severity, management, and requested mid-stream urine culture. Participants recorded, in a diary, symptom severity each day for 14 days. Time to recovery was compared between patient characteristics and between countries using two-level Cox proportional hazards models, with patients nested within practices. RESULTS: In total, 797 females attending primary care networks in England (n = 246, 30.9% of cohort), Wales (n = 213, 26.7%), the Netherlands (n = 133, 16.7%), and Spain (n = 205, 25.7%) were included. In total, 259 (35.8%, 95% confidence interval 32.3 to 39.2) of 726 females for whom there was a result were urine culture positive for UTI. Pathogens and antibiotic sensitivities were similar. Empirical antibiotics were prescribed for 95.1% in England, 92.9% in Wales, 95.1% in Spain, and 59.4% in the Netherlands There were no meaningful differences at a country network level before and after controlling for severity, prior UTIs, and antibiotic prescribing. CONCLUSION: Variation in presentation and management of uncomplicated UTI at a country primary care network level is clinically unwarranted and highlights a lack of consensus concerning optimal symptom control and antibiotic prescribing.
show less
Download/Full Text
Not available. The author may have various reasons for not providing access, for instance because it is prohibited by the commissioner of the research, or because the author is conducting further research on the subject.
Author keywords: antibiotic prescribing, antibiotic resistance, Gram-negative infections, practice patterns, physicians’, primary care, urinary tract infections
ISSN: 0960-1643
Note: © British Journal of General Practice 2017.
(Publisher version, Peer reviewed)