Abstract
BackgroundThere is a marked variation in both antibiotic prescribing practice and urine sampling rates for diagnostic microbiology across general practices in England. To help understand factors driving this variation, we undertook a survey in 2012/13 to determine sampling protocols and antibiotic formularies used by general practitioners (GPs) for managing urinary tract infections (UTIs) in the West Midlands region of England.MethodCross-sectional survey of all eligible general practices in the West Midlands region of England undertaken in November 2012. GPs were invited to complete an online survey questionnaire to gather information on policies used within the practice for urine sampling for microbiological examination, and the source of antibiotic formularies used to guide treatment of UTIs. The questionnaire also gathered information on how they would manage five hypothetical clinical scenarios encountered in the community.ResultsThe response rate was 11.3 % (409/3635 GPs), equivalent to a practice response rate of 26 % (248/950). Only 50 % of GPs reported having a practice policy for urine sampling. Although there was good agreement from GPs regarding collecting specimens in scenarios symbolising treatment failure (98 %), UTI in an adult male (98 %) and asymptomatic UTI in pregnancy (97 %), there was variation in GPs requesting a specimen for the scenarios involving a suspected uncomplicated urinary tract infection (UTI) and an asymptomatic catheterised elderly patient; with 40 and 38 % respectively indicating they would collect a specimen for microbiological examination.ConclusionStandardised evidence based clinical management policies and antibiotic formularies for GPs should be readily available. This will promote the rational use of diagnostic microbiology services, improve antimicrobial stewardship and aid the interpretation of ongoing antimicrobial resistance surveillance.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-1559-2) contains supplementary material, which is available to authorized users.
Highlights
There is a marked variation in both antibiotic prescribing practice and urine sampling rates for diagnostic microbiology across general practices in England
There was good agreement from general practitioner (GP) regarding collecting specimens in scenarios symbolising treatment failure (98 %), urinary tract infections (UTIs) in an adult male (98 %) and asymptomatic UTI in pregnancy (97 %), there was variation in GPs requesting a specimen for the scenarios involving a suspected uncomplicated urinary tract infection (UTI) and an asymptomatic catheterised elderly patient; with 40 and 38 % respectively indicating they would collect a specimen for microbiological examination
Standardised evidence based clinical management policies and antibiotic formularies for GPs should be readily available. This will promote the rational use of diagnostic microbiology services, improve antimicrobial stewardship and aid the interpretation of ongoing antimicrobial resistance surveillance
Summary
There is a marked variation in both antibiotic prescribing practice and urine sampling rates for diagnostic microbiology across general practices in England. The UK five year AMR Strategy recommends the strengthening of AMR surveillance to inform local prescribing and Antimicrobial susceptibility data from diagnostic microbiology laboratories can be used for surveillance to monitor trends in AMR [3]. This data is based on specimens submitted to laboratories and may be subject to selection bias due to over sampling of clinical specimens from patients with initial treatment failures, complicated clinical histories or severe infections [4, 5]. In England in 2009, there was a fivefold difference in antibiotic prescribing volume between general practices [8], with 74 % of antibiotic prescribing occurring in community settings in 2014 [9]
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