Predictors of Symptom Duration and Bacteriuria in Uncomplicated Urinary Tract Infection

Marianne Bollestad,Ingvild Vik,Nils Grude,Morten Lindbæk

doi:10.1080/02813432.2018.1499602

Abstract

Objective: To identify baseline predictors of symptom duration after empirical treatment for uncomplicated urinary tract infection (UTI) and significant bacteriuria in a cohort of women treated for UTI.Design: Prospective single-centre cohort study.Setting: Outpatient clinic in Norway.Patients: From September 2010 to November 2011, 441 women aged 16–55 years with symptoms of uncomplicated UTI were included.Results: Dipstick findings of leukocyte esterase 1 + (incidence rate ratio (IRR) 1.93, 95% confidence interval (CI) 1.23–3.01, p < 0.01) and microbe resistant to mecillinam treatment (IRR 1.41, 95% CI 1.07–1.89, p = 0.02) predicted longer symptom duration. More pronounced symptoms did not predict longer symptom duration (IRR 1.18, 95% CI 0.94–1.46, p = 0.15) or significant bacteriuria (odds ratio [OR] 1.16, 95% CI 0.72–1.88, p = 0.54). Leukocyte esterase 2 + (OR 2.51, 95% CI 0.92–6.83, p = 0.07) or 3 + (OR 2.40, 95% CI 0.88–6.05, p = 0.09) and nitrite positive urine dipstick test (OR 3.22, 95% CI 1.58–7.01, p = <0.01) were associated with bacteriuria.Conclusion: More pronounced symptoms did not correlate with significant bacteriuria or symptom duration after empirical treatment for acute cystitis. One might reconsider the current practice of treating uncomplicated UTI based on symptoms alone.Key PointsTreatment strategies for milder infectious diseases must consider ways of reducing antibiotic consumption to decelerate the increase in antibiotic resistance. Our findings suggest that more emphasis should be put on urine dipstick results and bacteriological findings in the clinical setting. One might reconsider the current practice of treating uncomplicated UTIs based on symptoms alone.

Highlights

Urinary tract infections (UTIs) are one of the most common bacterial infections encountered in the primary care setting
Logistic regression analysis showed that neither age nor more pronounced clinical symptoms upon presentation correlated with the presence of significant bacteriuria
Our study identified the presence of leukocyte esterase (2þ, 3þ) and nitrite on the urinary dipstick test as significant predictors of the presence of bacteriuria

Summary

Introduction

Urinary tract infections (UTIs) are one of the most common bacterial infections encountered in the primary care setting. Most women experience at least one episode of acute uncomplicated cystitis in their lifespan [1, 2]. Women report diversity in symptom burden in relation to an episode of uncomplicated UTI [3]. Antibiotics prescribed in primary care account for around 85% of the total human antibiotic consumption in Norway [4]. Refraining from treatment has been found to be inferior for both symptomatic and bacteriological cure of uncomplicated UTI [7,8,9]. A study of ibuprofen versus fosfomycin for the treatment of uncomplicated UTI found that two-thirds of women recovered without antibiotics [10]. Subgroup analysis of the patients found that five factors predicted the need for subsequent antibiotic treatment: urgency/frequency, impaired daily activities, and positive urine dipstick test results for erythrocytes, leukocyte esterase and nitrite [11]

Methods

Results

Conclusion