scholarly journals Clinicians’ interpretations of point of care urine culture versus laboratory culture results: analysis from the four-country POETIC trial of diagnosis of uncomplicated urinary tract infection in primary care

2017 ◽  
Vol 34 (4) ◽  
pp. 392-399 ◽  
Author(s):  
Saskia Hullegie ◽  
Mandy Wootton ◽  
Theo J.M. Verheij ◽  
Emma Thomas-Jones ◽  
Janine Bates ◽  
...  
Keyword(s):  
Primary Care ◽  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Urine Culture ◽  
Point Of Care ◽  
Laboratory Culture ◽  
Uncomplicated Urinary Tract Infection

scholarly journals Point-of-care urine culture for managing urinary tract infection in primary care: a randomised controlled trial of clinical and cost-effectiveness

2018 ◽  
Vol 68 (669) ◽  
pp. e268-e278 ◽  
Author(s):  
Christopher C Butler ◽  
Nick A Francis ◽  
Emma Thomas-Jones ◽  
Mirella Longo ◽  
Mandy Wootton ◽  
...  
Keyword(s):  
Primary Care ◽  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Standard Care ◽  
Urine Culture ◽  
Point Of Care ◽  
Antibiotic Use ◽  
Laboratory Culture ◽  
Uncomplicated Urinary Tract Infection

BackgroundThe effectiveness of using point-of-care (POC) urine culture in primary care on appropriate antibiotic use is unknown.AimTo assess whether use of the Flexicult™ SSI-Urinary Kit, which quantifies bacterial growth and determines antibiotic susceptibility at the point of care, achieves antibiotic use that is more often concordant with laboratory culture results, when compared with standard care.Design and settingIndividually randomised trial of females with uncomplicated urinary tract infection (UTI) in primary care research networks (PCRNs) in England, the Netherlands, Spain, and Wales.MethodMultilevel regression compared outcomes between the two groups while controlling for clustering.ResultsIn total, 329 participants were randomised to POC testing (POCT) and 325 to standard care, and 324 and 319 analysed. Fewer females randomised to the POCT arm than those who received standard care were prescribed antibiotics at the initial consultation (267/324 [82.4%] versus 282/319 [88.4%], odds ratio [OR] 0.56, 95% confidence interval [CI] = 0.35 to 0.88). Clinicians indicated the POCT result changed their management for 190/301 (63.1%). Despite this, there was no statistically significant difference between study arms in antibiotic use that was concordant with laboratory culture results (primary outcome) at day 3 (39.3% POCT versus 44.1% standard care, OR 0.84, 95% CI = 0.58 to 1.20), and there was no evidence of any differences in recovery, patient enablement, UTI recurrences, re-consultation, antibiotic resistance, and hospitalisations at follow-up. POCT culture was not cost-effective.ConclusionPoint-of-care urine culture was not effective when used mainly to adjust immediate antibiotic prescriptions. Further research should evaluate use of the test to guide initiation of ‘delayed antibiotics’.

scholarly journals Variations in presentation, management, and patient outcomes of urinary tract infection: a prospective four-country primary care observational cohort study

2017 ◽  
Vol 67 (665) ◽  
pp. e830-e841 ◽  
Author(s):  
Christopher C Butler ◽  
Nick Francis ◽  
Emma Thomas-Jones ◽  
Carl Llor ◽  
Emily Bongard ◽  
...  
Keyword(s):  
Primary Care ◽  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
The Netherlands ◽  
Symptom Severity ◽  
Urine Culture ◽  
Symptom Control ◽  
Antibiotic Prescribing ◽  
Uncomplicated Urinary Tract Infection

BackgroundRegional 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.AimTo 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 settingProspective observational study of females with symptoms of uncomplicated UTI presenting to primary care networks in England, Wales, the Netherlands, and Spain.MethodClinicians 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.ResultsIn 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.ConclusionVariation 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.

scholarly journals Construction of a patient decision aid for the treatment of uncomplicated urinary tract infection in primary care

2020 ◽  
Author(s):  
Yves-Marie VINCENT ◽  
Adèle FRACHON ◽  
Clotilde BUFFETEAU ◽  
Guillaume CONORT
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Decision Aid ◽  
Uncomplicated Urinary Tract Infection ◽  
Shared Decision ◽  
Patient Decision Aid ◽  
Patient Decision

Abstract Background: Uncomplicated urinary tract infection (uUTI) is a frequent disorder in general practice. The risk of developing pyelonephritis remains low after uUTI, nonetheless, empiric antibiotic therapy is frequently prescribed for symptomatic purposes. This can lead to adverse effects and antibiotic resistance. Furthermore, patients sometimes wish to avoid taking antibiotics. Some European countries recommend discussing a delayed prescription with the patient and developing a shared decision. The aim of our study is to develop a patient decision aid (PtDA) that can be used in primary care to make a shared decision about whether to treat uUTI with antibiotics or not.Methods: We followed the steps recommended by the International Patient Decision Aids Standards, with a scoping phase, a design phase (including focus groups and literature review),and an alpha-testing phase. A steering group, made up of patients and physicians, met throughout the study to develop a draft and then a final version of a prototype PtDA.Results: The information included in the PtDA is the definition of uUTI, information on the options, their benefits, risks, and consequences, based on a review of the literature. The results of the focus group made it possible to determine the patient's values and preferences to be considered in decision-making, namely: the discomfort felt, the impact on daily life, the representations of antibiotics, and the position relative to the risk of adverse effect. The choices of presentation, organisation and design are the result of the work of the steering group, improved by feedback from alpha testing.Conclusions: Our results confirm a need for shared decision-making and the equipoise in this situation. More advice from outside physicians is still lacking. This PtDA needs to be validated in a beta-testing phase, and then tested in a clinical study comparing its use with the systematic prescription approach.

scholarly journals Construction of a patient decision aid for the treatment of uncomplicated urinary tract infection in primary care

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Yves-Marie Vincent ◽  
Adèle Frachon ◽  
Clotilde Buffeteau ◽  
Guillaume Conort
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Decision Aid ◽  
Uncomplicated Urinary Tract Infection ◽  
Shared Decision ◽  
Patient Decision Aid ◽  
Patient Decision

Abstract Background Uncomplicated urinary tract infection (uUTI) is very common among women in primary care. The risk of developing pyelonephritis remains low after uUTI, nonetheless, empiric antibiotic therapy is frequently prescribed for symptomatic purposes. This may lead to adverse effects and antibiotic resistance. Furthermore, patients may express the will to limit the use of antibiotics. Some European countries recommend discussing a delayed prescription with the patient and developing a shared decision. The aim of this study is to create a patient decision aid (PtDA) used in primary care settings to make a shared decision between practitioners and women about whether or not to treat uUTI with antibiotics. Methods We followed the steps recommended by the International Patient Decision Aids Standards, with a scoping phase, a design phase (including focus groups and literature review), and an alpha-testing phase. A steering group, made of patients and physicians, met throughout the study to develop a prototype PtDA. Results The information included in the PtDA is the definition of uUTI, information on the options, their benefits, risks, and consequences, based on a review of the literature. The results of the focus group made possible to determine the patient’s values and preferences to consider in decision-making, including: the discomfort felt, the impact on daily life, patients’ perceptions of antibiotics, and the position relative to the risk of adverse effect. The choices in presentation, organisation and design are the result of the work of the steering group, improved by feedback from alpha testing. We confirmed the need for shared decision-making and the equipoise in this situation. Conclusions We developed a PtDA to be used in primary care for sharing decision on the use of antibiotic in uUTI. It needs to be validated in a beta-testing phase, with complementary advice from peers, and then tested in a clinical study comparing its use with the systematic prescription approach.

scholarly journals 76. Uncomplicated Urinary Tract Infections in the Multi-resistance Era: Is It Time of Microbiologic Diagnosis? An Observational Study in Buenos Aires City

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S155-S155
Author(s):  
Alvaro Otreras ◽  
Sofia Sabato ◽  
Daniela D′Alessandro ◽  
Sylvia Errea ◽  
Edgardo Bottaro ◽  
...  
Keyword(s):  
Urinary Tract Infection ◽  
Multivariate Analysis ◽  
Urinary Tract ◽  
Tract Infection ◽  
Observational Study ◽  
Clinical Diagnosis ◽  
Urine Culture ◽  
First Episode ◽  
Uncomplicated Urinary Tract Infection ◽  
Tract Infections

Abstract Background Uncomplicated urinary tract infection (uUTI) is one of the main causes of antibiotics prescription in outpatient setting. Current recommendations, based on studies from pre-antimicrobial resistance era, suggest that diagnosis of uUTI can be made based on clinical symptoms and that urine analysis leads only to a minimal increase in diagnostic accuracy. We analyzed urine cultures (UC) from patients with clinical diagnosis. Methods Prospective and observational study carried out in an Emergency Department during August 2016 to August 2017. Women older than 15 years with 2 or more classic symptoms of uUTI and the absence of vaginal discharge and irritation were included. Those with complicated and recurrent urinary tract infection (UTI) were excluded. Urine cytology and UC were performed in all episodes. A bivariate and multivariate analysis was performed considering the probability of having a positive urine culture according to the different symptomatology variables. Results We enrolled 208 patients, with a median age of 25 (14-68 years). Previous UTI 6 (2.9%), previous antibiotic (last 3 months) 20 (9.6%). Inflammatory cytology 173 (83.2%), positive UC 109 (52.4%), cystitis 155 (74.5%). Symptoms: dysuria 154 (74%), frequency 111 (53.4%), tenesmus 97 (46.6%), fever 78 (37.5%), hematuria 43 (20, 7%), hypogastric pain 128 (61.5%), back pain 84 (40.4%). Combinations of 3 or more classic symptoms occurred in 52 (25%) episodes. The most frequent association was dysuria, frequency and tenesmus. No statistically significant association was found either in the bivariate or multivariate analysis in relation to presenting positive UC (Tables 1 and 2). Conclusion The results show that almost 50% of the patients with a clinical diagnosis of UTI had a negative urine culture. We consider it necessary to rethink the prescription of antibiotics without microbiological confirmation in the first episode of uUTI as a strategy to reduce inappropriate use of antibiotics. Disclosures All Authors: No reported disclosures

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