Abstract
Urinary tract infections (UTIs) are common in general practice, and antibiotic resistance is often seen. Urine cultures are advised by the Dutch national UTI guideline for patients at high risk of UTI complications. Prudent use of antibiotics and taking into account national guidelines and urine culture results are important to combat antibiotic resistance in general practice. To identify subgroups of UTI patients in which the use of urine cultures and antibiotic prescriptions deviates from the national guidelines. We investigated associations of several characteristics with urine culture orders in patients with UTI in 2015 from seven Dutch general practices (n=1295). These included subgroups at risk for UTI complications, comorbidities, age and history of UTI recurrence. In addition, we assessed the level of adherence to the guideline for antibiotic prescriptions in subgroups at risks for UTI complications. Urine cultures were ordered in 17% (n=221) of patients, more frequently in high-risk patients (32%) than in low-risk patients (7%), for UTI complications (OR=6.4; 95% CI 4.6-9.0). In low-risk patients, 91% received antibiotics that were recommended in the guideline. For high-risk patients this percentage ranged widely, and was particularly low in the risk groups with signs of tissue invasion (29-50%). Diagnostic and therapeutic adequacy can still be improved by increasing the adherence to the guideline in UTI patients at high risk for complications. This may contribute to containing antibiotic resistance in UTI by ordering urine cultures and use the results to adjust prescriptions to antibiotic susceptibility of the uropathogen.
Highlights
Resistance to antibiotics is a worldwide problem, which may be reduced by prescribing less antibiotics and reducing inappropriate prescriptions (Wise et al, 1998; Butler et al, 2007)
We investigate the influence of established risk factors for Urinary tract infections (UTIs) complications, common comorbidities, age and a history of recurrent UTI on urine culture requests
We evaluated the compliance of General Practitioners (GPs) to the national guideline (Van Pinxteren et al, 2013) for the use of urine cultures and the type of prescribed antibiotics with descriptive statistics and χ2-tests
Summary
Resistance to antibiotics is a worldwide problem, which may be reduced by prescribing less antibiotics and reducing inappropriate prescriptions (Wise et al, 1998; Butler et al, 2007). The guideline of Dutch College of General Practitioners (GPs) on UTI (NHG-guideline) (Van Pinxteren et al, 2013) recommends a urine culture and specific antibiotics for these high-risk patients. If a culture is ordered, the guideline recommends that antibiotics should be started empirically in anticipation of the culture result, after which a switch can be made if resistance is seen. This Dutch guideline is very similar to the UK guideline for GPs (Health Protection Agency, 2011), with the exception of two risk factors: recurrent UTI is not considered a risk factor for complications in the Dutch guideline, whereas, on the other hand, immune disorders are not Downloaded from https://www.cambridge.org/core. We investigate the influence of established risk factors for UTI complications (eg pregnancy, immunodeficiency), common comorbidities (like cardiovascular or pulmonary diseases), age and a history of recurrent UTI on urine culture requests
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