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

British Journal of General Practice

Volumn 67, Issue 665, 2017, Pages e830-e841

  Butler, Christopher C ^a   Francis, Nick ^b   Thomas Jones, Emma ^b   Llor, Carl ^c   Bongard, Emily ^a   Moore, Michael ^d   Little, Paul ^d   Bates, Janine ^b   Lau, Mandy ^b   Pickles, Timothy ^b   Gal, Micaela ^b   Wootton, Mandy ^e   Kirby, Nigel ^b   Gillespie, David ^b   Rumbsy, Kate ^d   Brugman, Curt ^f   Hood, Kerenza ^b   Verheij, Theo ^f  

^a UNIVERSITY OF OXFORD   (United Kingdom)

^b CARDIFF UNIVERSITY   (United Kingdom)

^c Primary Healthcare Centre Via Roma ^*  (Spain)

^d UNIVERSITY OF SOUTHAMPTON   (United Kingdom)

^e UNIVERSITY HOSPITAL OF WALES   (United Kingdom)

^f UNIVERSITY MEDICAL CENTER UTRECHT   (Netherlands)

Author keywords

Antibiotic prescribing; Antibiotic resistance; Gram negative infections; Physicians'; Practice patterns; Primary care; Urinary tract infections

Indexed keywords

AMOXICILLIN; AMOXICILLIN PLUS CLAVULANIC ACID; CEFALEXIN; CEFOTAXIME; CEFTAZIDIME; CEPHALOSPORIN DERIVATIVE; CIPROFLOXACIN; ERTAPENEM; FOSFOMYCIN; GENTAMICIN; IBUPROFEN; METICILLIN; NITROFURANTOIN; PARACETAMOL; TEMOCILLIN; TRIMETHOPRIM; ANTIINFECTIVE AGENT;

ADULT; ANTIBIOTIC SENSITIVITY; ARTICLE; BODY TEMPERATURE; COAGULASE NEGATIVE STAPHYLOCOCCUS; COHORT ANALYSIS; CONSULTATION; CONTROLLED STUDY; CRANBERRY JUICE; DIPSTICK TEST; DISEASE SEVERITY; ENGLAND; ESCHERICHIA COLI; FEMALE; FOLLOW UP; HUMAN; MAJOR CLINICAL STUDY; NETHERLANDS; OBSERVATIONAL STUDY; PRESCRIPTION; PRIMARY MEDICAL CARE; PROSPECTIVE STUDY; SPAIN; URINALYSIS; URINARY TRACT INFECTION; URINE CULTURE; WALES; ANALYSIS OF VARIANCE; CLINICAL PRACTICE; CLINICAL TRIAL; MIDDLE AGED; MULTICENTER STUDY; PATIENT REFERRAL; PRIMARY HEALTH CARE; PROCEDURES; STATISTICS AND NUMERICAL DATA; TREATMENT OUTCOME;

ADULT; ANALYSIS OF VARIANCE; ANTI-BACTERIAL AGENTS; ENGLAND; FEMALE; FOLLOW-UP STUDIES; HUMANS; MIDDLE AGED; NETHERLANDS; PRACTICE PATTERNS, PHYSICIANS'; PRIMARY HEALTH CARE; PROSPECTIVE STUDIES; REFERRAL AND CONSULTATION; SPAIN; TREATMENT OUTCOME; URINALYSIS; URINARY TRACT INFECTIONS; WALES;

EID: 85037043922     PISSN: 09601643     EISSN: 14785242     Source Type: Journal    
DOI: 10.3399/bjgp17X693641     Document Type: Article

References (35)

1. Philips H, Huibers L, Holm Hansen E, et al. Guidelines adherence to lower urinary tract infection treatment in out-of-hours primary care in European countries. Qual Prim Care 2014; 22(4): 221-231.
2. Hawker JI, Smith S, Smith GE, et al. Trends in antibiotic prescribing in primary care for clinical syndromes subject to national recommendations to reduce antibiotic resistance, UK 1995-2011: analysis of a large database of primary care consultations. J Antimicrob Chemother 2014; 69(12): 3423-3430.
3. Ironmonger D, Edeghere O, Bains A, et al. Surveillance of antibiotic susceptibility of urinary tract pathogens for a population of 5.6 million over 4 years. J Antimicrob Chemother 2015; 70(6): 1744-1750.
4. Bush K, Courvalin P, Dantas G, et al. Tackling antibiotic resistance. Nat Rev Microbiol 2011; 9(12): 894-896.
5. Butler CC, Hood K, Verheij T, et al. Variation in antibiotic prescribing and its impact on recovery in patients with acute cough in primary care: prospective study in 13 countries. BMJ 2009; 338: b2242.
6. Wennberg JE. Forty years of unwarranted variation - and still counting. Health Policy 2014; 114(1): 1-2.
7. Wood F, Simpson S, Butler CC. Socially responsible antibiotic choices in primary care: a qualitative study of GPs' decisions to prescribe broad-spectrum and fluroquinolone antibiotics. Fam Pract 2007; 24(5): 427-434.
8. Wood F, Phillips C, Brookes-Howell L, et al. Primary care clinicians' perceptions of antibiotic resistance: a multi-country qualitative interview study. J Antimicrob Chemother 2013; 68(1): 237-243.
9. Foxman B. Epidemiology of urinary tract infections: incidence, morbidity, and economic costs. Am J Med 2002; 113(Suppl 1A): 5S-13S.
10. Butler CC, Hawking MK, Quigley A, McNulty CA. Incidence, severity, help seeking, and management of uncomplicated urinary tract infection: a population-based survey. Br J Gen Pract 2015; DOI: https://doi.org/10.3399/bjgp15X686965.
11. O'Brien K, Hillier S, Simpson S, et al. An observational study of empirical antibiotics for adult women with uncomplicated UTI in general practice. J Antimicrob Chemother 2007; 59(6): 1200-1203.
12. Little P, Merriman R, Turner S, et al. Presentation, pattern, and natural course of severe symptoms, and role of antibiotics and antibiotic resistance among patients presenting with suspected uncomplicated urinary tract infection in primary care: observational study. BMJ 2010; 340: b5633.
13. McIsaac WJ, Low DE, Biringer A, et al. The impact of empirical management of acute cystitis on unnecessary antibiotic use. Arch Intern Med 2002; 162(5): 600-605.
14. Nazareth I, King M. Decision making by general practitioners in diagnosis and management of lower urinary tract symptoms in women. BMJ 1993; 306(6885): 1103-1106.
15. Vellinga A, Cormican M, Hanahoe B, et al. Antimicrobial management and appropriateness of treatment of urinary tract infection in general practice in Ireland. BMC Fam Pract 2011; 12(1): 108.
16. Nicolle LE, AMMI Canada Guidelines Committee. Complicated urinary tract infection in adults. Can J Infect Dis Med Microbiol 2005; 16(6): 349-360.
17. Flottorp S, Oxman AD, Havelsrud K, et al. Cluster randomised controlled trial of tailored interventions to improve the management of urinary tract infections in women and sore throat. BMJ 2002; 325(7360): 367.
18. Little P, Turner S, Rumsby K, et al. Validating the prediction of lower urinary tract infection in primary care: sensitivity and specificity of urinary dipsticks and clinical scores in women. Br J Gen Pract 2010; DOI: https://doi.org/10.3399/bjgp10X514747.
19. Grabe M, Bjerklund-Johansen TE, Botto H, et al. Guidelines on urological infections. European Association of Urology, 2013. http://uroweb.org/wp-content/uploads/18-Urological-infections-LR.pdf (accessed 9 Nov 2017).
20. Health Protection Agency. Diagnosis of UTI: Quick reference guide for primary care. https://www.gov.uk/government/uploads/system/uploads/attachment-data/file/323398/UTI-guidelines-with-RCGP-logo.pdf (accessed 9 Nov 2017).
21. Snijders TAB, Bosker RJ. Multilevel analysis: an introduction to basic and advanced multilevel modeling. London: Sage, 2012.
22. Hardy MA. Regression with dummy variables. Newbury Park, CA: Sage, 1993.
23. André M, Mölstad S, Lundborg CS, et al. Management of urinary tract infections in primary care: a repeated 1-week diagnosis-prescribing study in five counties in Sweden in 2000 and 2002. Scand J Infect Dis 2004; 36(2): 134-138.
24. Canbaz S, Peksen Y, Tevfik Sunter A, et al. Antibiotic prescribing and urinary tract infection. Int J Antimicrob Agents 2002; 20(6): 407-411.
25. Fahey T, Webb E, Montgomery AA, Heyderman RS. Clinical management of urinary tract infection in women: a prospective cohort study. Fam Pract 2003; 20(1): 1-6.
26. Galatti L, Sessa A, Mazzaglia G, et al. Antibiotic prescribing for acute and recurrent cystitis in primary care: a 4 year descriptive study. J Antimicrob Chemother 2006; 57(3): 551-556.
27. Hummers-Pradier E, Ohse AM, Koch M, et al. Management of urinary tract infections in female general practice patients. Fam Pract 2005; 22(1): 71-77.
28. Martinez MA, Inglada L, Ochoa C, et al. Assessment of antibiotic prescription in acute urinary tract infections in adults. J Infect 2007; 54(3): 235-244.
29. Skerk V, Skerk V, Jaksic J, et al. Research of urinary tract infections in family medicine physicians' offices - empiric antimicrobial therapy of urinary tract infections - Croatian experience. Coll Antropol 2009; 33(2): 625-631.
30. Llor C, Rabanaque G, Lopez A, Cots JM. The adherence of GPs to guidelines for the diagnosis and treatment of lower urinary tract infections in women is poor. Fam Pract 2011; 28(3): 294-299.
31. Etienne M, Lefebvre E, Frebourg N, et al. Antibiotic treatment of acute uncomplicated cystitis based on rapid urine test and local epidemiology: lessons from a primary care series. BMC Infect Dis 2014; 14: 137.
32. Willems CS, van den Broek D'Obrenan J, Numans ME, et al. Cystitis: antibiotic prescribing, consultation, attitudes and opinions. Fam Pract 2014; 31(2): 149-155.
33. Vellinga A, Galvin S, Duane S, et al. Intervention to improve the quality of antimicrobial prescribing for urinary tract infection: a cluster randomized trial. CMAJ 2016; 188(2): 108-115.
34. Gagyor I, Haasenritter J, Bleidorn J, et al. Predicting antibiotic prescription after symptomatic treatment for urinary tract infection: development of a model using data from an RCT in general practice. Br J Gen Pract 2016; DOI: https://doi.org/10.3399/bjgp16X684361.
35. McLellan LK, Hunstad DA. Urinary tract infection: pathogenesis and outlook. Trends Mol Med 2016; 22(11): 946-957.