PT  - JOURNAL ARTICLE
AU  - Christopher C Butler
AU  - Nick Francis
AU  - Emma Thomas-Jones
AU  - Carl Llor
AU  - Emily Bongard
AU  - Michael Moore
AU  - Paul Little
AU  - Janine Bates
AU  - Mandy Lau
AU  - Timothy Pickles
AU  - Micaela Gal
AU  - Mandy Wootton
AU  - Nigel Kirby
AU  - David Gillespie
AU  - Kate Rumbsy
AU  - Curt Brugman
AU  - Kerenza Hood
AU  - Theo Verheij
TI  - Variations in presentation, management, and patient outcomes of urinary tract infection: a prospective four-country primary care observational cohort study
AID  - 10.3399/bjgp17X693641
DP  - 2017 Dec 01
TA  - British Journal of General Practice
PG  - e830--e841
VI  - 67
IP  - 665
4099  - http://bjgp.org/content/67/665/e830.short
4100  - http://bjgp.org/content/67/665/e830.full
SO  - Br J Gen Pract2017 Dec 01; 67
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.