TY - JOUR
T1 - Variations in presentation, management, and patient outcomes of urinary tract infection
T2 - a prospective four-country primary care observational cohort study
AU - Butler, Christopher C.
AU - Francis, Nick A.
AU - Thomas-Jones, Emma
AU - Llor, Carl
AU - Bongard, Emily
AU - Moore, Michael
AU - Little, Paul
AU - Bates, Janine
AU - Lau, Mandy
AU - Pickles, Timothy
AU - Gal, Micaela
AU - Wootton, Mandy
AU - Kirby, Nigel
AU - Gillespie, David
AU - Rumbsy, Kate
AU - Brugman, Curt
AU - Hood, Kerenza
AU - Verheij, Theo
N1 - Publisher Copyright:
© 2017 British Journal of General Practice.
PY - 2017/12
Y1 - 2017/12
N2 - 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, 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.
AB - 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, 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.
KW - Gram-negative infections
KW - antibiotic prescribing
KW - antibiotic resistance
KW - physicians’
KW - practice patterns
KW - primary care
KW - urinary tract infections
U2 - 10.3399/bjgp17X693641
DO - 10.3399/bjgp17X693641
M3 - Article
C2 - 29158245
SN - 0960-1643
VL - 67
SP - e830-e841
JO - British Journal of General Practice
JF - British Journal of General Practice
IS - 665
ER -