RT Journal Article
SR Electronic
T1 Variations in presentation, management, and patient outcomes of urinary tract infection: a prospective four-country primary care observational cohort study
JF British Journal of General Practice
JO Br J Gen Pract
FD British Journal of General Practice
SP e830
OP e841
DO 10.3399/bjgp17X693641
VO 67
IS 665
A1 Christopher C Butler
A1 Nick Francis
A1 Emma Thomas-Jones
A1 Carl Llor
A1 Emily Bongard
A1 Michael Moore
A1 Paul Little
A1 Janine Bates
A1 Mandy Lau
A1 Timothy Pickles
A1 Micaela Gal
A1 Mandy Wootton
A1 Nigel Kirby
A1 David Gillespie
A1 Kate Rumbsy
A1 Curt Brugman
A1 Kerenza Hood
A1 Theo Verheij
YR 2017
UL http://bjgp.org/content/67/665/e830.abstract
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.