In:
British Journal of General Practice, Royal College of General Practitioners, Vol. 67, No. 665 ( 2017-12), p. e830-e841
Abstract:
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, 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.
Type of Medium:
Online Resource
ISSN:
0960-1643
,
1478-5242
DOI:
10.3399/bjgp17X693641
Language:
English
Publisher:
Royal College of General Practitioners
Publication Date:
2017
detail.hit.zdb_id:
2097982-4
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