Therapeutic Adequacy Research Articles

Adecuación de las prescripciones médicas en faringitis estreptocócicas y otitis media aguda a las guías terapéuticas

Background and objective: to analyze the degree of adequacy to consensus therapeutic guidelines in acute pharyngotonsillitis and acute otitis media of primary care pediatricians. Material and Methods: retrospective observational study with data collection from electronic medical records of patients with suppurative AOM and streptococcal AAF in patients from 0 to 14 years of age residing in Araba, in an 18-month period study. Results: in the group of patients with suppurative AOM, 238 episodes have been evaluated, with a degree of therapeutic adequacy of 56.7%, being underdosing the main cause of inadequacy. In the group of patients with streptococcal AAF, 1721 episodes have been evaluated, with a degree of therapeutic adequacy of 57%, being the main causes of inadequacy overdose and short-duration regimens. Conclusion: in both suppurative AOM and streptococcal AAF, the degree of therapeutic adequacy is somewhat lower than in other analysed studies. To achieve a correct treatment in these processes in primary care settings is of vital importance due to its high frequency of diagnosis. It is also important to improve the quality of registered data in medical records of all patients.

HTA challenges for personalized medicine: the case of liquid biopsy for lung cancer

Abstract Background Personalized medicine and related health technologies are growing rapidly. In this context, health technology assessment methodologies must be prepared and adapted. Evaluating liquid biopsy (LB) for the diagnosis, treatment indication and prognosis of lung cancer is an example of the challenges in the personalized medicine assessment. Methods A systematic review and metanalysis based on EUnetHTA CoreModel. Review question: What is the effectiveness of LB for the diagnosis, therapeutic adequacy and prognosis of lung cancer versus tissue biopsy? The Covidence software was used for the systematic review and MetaDiSC software for the meta-analysis. The quality of the included systematic reviews was assessed with AMSTAR-2 and the quality of the clinical studies with QUADAS-II. Results 69 systematic reviews corresponding to different therapeutic purposes: 12 for treatment adequacy, 47 for diagnosis and 13 for prognosis. Also 24 clinical trials were included. The omics alterations analysed were: punctual mutations in EGFR, BRAF, KRAS and ALK, methylation patterns, lncRNA expression, detection of circulating tumour cells, quantification of circulating DNA, NGS analysis of point mutations, miRNA expression and analysis of exosome content. Conclusions Use of LB tests at different disease stages and need of individual validation for the biomolecules and mutations analysed, are the main challenges. An evaluation framework that includes the specificities of these technologies is necessary for their proper assessment. Key messages • Liquid biopsy may be an alternative to tissue biopsy. The evaluation of the biomolecules analysed should be disaggregated. • The particularities of personalised medicine technologies require assessment methodologies adapted to them.

Clinical Correlation of Retinal Fluid Fluctuation Represented by Fluctuation Index in Wet Age-Related Macular Degeneration: TOWER Study Report 2.

To explore outcomes and biomarkers associated with retinal fluid instability represented by a new parameter in neovascular age-related macular degeneration (nAMD). Patients with treatment-naïve nAMD receiving anti-vascular endothelial growth factor (VEGF) injections for a duration of 1 to 3 years were consecutively reviewed. Fluctuation Index (FI) of each eye, calculated by averaging the sum of differences in 1-mm central subfield thickness between each follow-up from months 3 to 24, was arranged into ascending order from the lowest to the highest and split equally into low, moderate, and high fluctuation groups. Outcomes were analyzed at 24 months. Of 558 eyes, FI values showed a negative correlation with a degree-response gradient with 24-month visual improvement. After controlling for baseline best-corrected visual acuity and potential confounders, eyes with low fluctuation gained more Early Treatment Diabetic Retinopathy Study letters than those in the moderate and high fluctuation group (Δ, 10.1 and 14.0 letters, respectively). Significant best-corrected visual acuity improvement from baseline to month 24 (11.8 letters) was observed exclusively in the low fluctuation group despite the indifference in the number of injections and types of anti-VEGF drug used among groups. Patients presenting with central subfield thickness of ≥405 µm or intraretinal fluid coinciding with subretinal fluid showed a significant association with foveal thickness instability during the maintenance phase. Apart from the central subfield thickness values, unstable macular thickening represented by the FI was associated with some baseline features and may contribute to substandard visual outcomes. FI may be a valuable tool for assessing therapeutic adequacy in the treatment of nAMD.

Adequate Chelation and Cupriuresis in Hepatic Wilson Disease Patients Under Combination (Chelator + Zinc) Therapy at 2 Years of Follow-up

Role of 24-h urinary copper excretion (UCE) in monitoring Wilson disease (WD) on combination (chelator+Zinc) therapy is not well studied, especially in the pediatric population. Hence, the present study is conducted with an aim to evaluate UCE and its role in deciding therapeutic adequacy in pediatric WD on long-term follow-up. All WD patients <18 years of age and on combination therapy with at least one UCE available after the first year of treatment were included. Liver biochemistries, UCE, and serum non-ceruloplasmin bound copper (NCC) were assessed at diagnosis and various follow-ups. For assessment of treatment efficacy, criteria for adequate chelation (CAC) were defined as fulfillment of both (i) AST & ALT ≤1.5 times upper limit of normal, serum albumin >35gm/L, INR <1.5 and (ii) UCE <500 mcg/day. Of the 74 included children, 70 (94.5%), 45 (60.8%), 28 (37.8%) and 21 (28.3%) completed 2-, 3-, 5-, and 7-year follow-up, respectively. Liver biochemistries improved significantly within 1 year of treatment. UCE (mcg/day) decreased significantly from baseline of 654.08±803.78 to 308.23±175.93 at 2 years with no further change at 3- and 5-years follow-up. UCE (mcg/day) at 2 years was <200 in 28.5%, 200-500 in 55.7%, and >500 in 15.7%. 61% achieved CAC in 2 years. On multivariate cox regression, treatment compliance was predictor for CAC achievement (Odds ratio: 3.48, 95%CI: 1.36-8.86. P=0.009). UCE declines significantly from baseline to <500 mcg/day within 2 years. Majority of treatment-compliant patients achieve CAC within 2 years of combination therapy.

Adequação terapêutica: apresentação de um protocolo hospitalar

Abstract Therapeutic adequacy is defined as a medical decision shared with patients and family members and that seeks to adjust therapeutic and diagnostic resources appropriate to each care plan. This article aims to present a protocol on therapeutic adequacy implemented in a university hospital. This protocol aims to guide practices of health professionals in the light of the bioethical, legal and clinical principles relevant to each case. It is concluded that the protocol can assist in the decisions to abstain or suspend certain treatment procedures of patients with severe, progressive and irreversible diseases.

Person-centred care provided by a multidisciplinary primary care team to improve therapeutic adequacy in polymedicated elderly patients (PCMR): randomised controlled trial protocol

IntroductionThe increase in elderly population has led to an associated increase in multiple pathologies, frailty, polypharmacy, healthcare costs, decreased quality of life and mortality. We designed an intervention based on...

Adequate chelation and cupriuresis in hepatic wilson disease patients under combination (chelator + zinc) therapy by 2 year follow up

Background and Aim: Role of 24-Hour Urinary copper excretion (UCE) in treatment monitoring of Wilson disease (WD) is not well studied especially in paediatric population. Hence, present study is conducted with aim to evaluate UCE and its role in deciding therapeutic adequacy in paediatric WD on long-term follow-up.

Adecuación de la prescripción de vitamina D en Atención Primaria

ObjectivesTo evaluate the adequacy of vitamin D treatment based on clinic evidence in a Primary Care Center as well as to analyze some characteristics of the prescriptions made. Materials and methodsDescriptive cross-sectional study. Primary Care. Patients above 14 years old with vitamin D prescription. Main variable was the therapeutic adequacy with vitamin D compounds (adequacy was considered when there was a clinical indication for treatment and blood vitamin D levels below 20ng/ml). Other clinical variables were collected. Frequency and association measures were used for statistical analysis. Level of statistical significance was considered <0.05. Results430 patients, 346 women (80.5%, 95% CI=77–84). Record of vitamin D values in 216 (50.2%, 95% CI=45–55). Screening/treatment indications in 219 patients (50.9%, 95% CI=46–56), of those in 150 patients vitamin D values were recorded (68.5%, 95% CI=62–75), average (±SD) was 21.22±12ng/ml, deficiency criteria in 86 (57.3%, 95% CI=51–64), insufficiency in 37 (24.7%, 95% CI=19–30) and sufficiency in 27 (18%, 95% CI=13–23). 86 patients (20%, 95% CI=16–24) had treatment indications plus vitamin D deficiency with no differences between genders. ConclusionsOnly 20% of the patients had treatment indications plus vitamin D deficiency. Female predominance. Just over half had indications for screening of serological vitamin D values and/or indications for treatment with vitamin D compounds.

Impact of a 5-year antimicrobial stewardship program focusing on fluoroquinolone prescriptions.

Within the context of the wide use of fluoroquinolones (FQs) and the emergence of multidrug-resistant bacteria, French recommendations concerning the appropriate use of systemic FQs in adults were published in 2015. This study assessed the impact of antibiotic stewardship intervention on the use of FQs over a 5-year period. Five annual audits were performed to evaluate FQ prescriptions. Following the baseline audit, a campaign of appropriate antibiotic use was initiated with courses on antibiotics including FQs. All audits included quantitative and qualitative evaluations to calculate an index of therapeutic adequacy (ITA) with six criteria: indication, molecule type, dosage, duration, route of administration and association. These audits were performed annually from 2015 to 2019. The number of prescriptions decreased substantially from 90 in 2015 to 17 in 2019. This reduction was consistent with consumption data, such that the defined daily dose for 1000 bed days diminished from 67 in 2015 to 42 in 2019. Between 2015 and 2016, the ITA decreased significantly from 3.27 to 1.79 (P = 0.001), corresponding to an improvement in prescription quality. The ITA stabilised between 2016 and 2019. Moreover, improvements were observed in the proportion of entirely conforming prescriptions, conformity of indications, choice of molecule type among FQs and proportion of prescriptions with non-conforming treatment durations. Between 2015 and 2019, we observed quantitative and qualitative improvements in FQ prescriptions within the hospital. Prescription follow-up through annual audits, combined with training courses, contributed to consistent results.

Improvement in communication during patient handoff between areas from a children's hospital.

Patient handoff is an interactive process including data communication and responsible transfer in order to safely maintain the continuity of care. Failure in this process may result in inadequate care and favor the occurrence of errors. To implement a standardized instrument for patient handoff from the intensive care unit (ICU) to the intermediate-medium care unit (IMCU), and compare communication between health care providers before and after the intervention. Before-and-after study conducted at Hospital de Pediatría "Prof. Dr. Juan P. Garrahan." The intervention consisted in a written handoff form. The pre-intervention sample included patients transferred from ICUs to IMCUs between October 1st and October 31st, 2015. The post-intervention sample included patients transferred between March 1st and March 31st, 2016. A total of 4 IMCUs and 3 ICUs participated in the study. The main study variable was the written part of the handoff; in particular, whether it was timely and complete. A total of 50 handoffs were analyzed for each stage. With the written handoff, there was an increase in the communication of clinical data in 88 % of variables (oral communication between physicians, treating physician, therapeutic adequacy, diagnosis, course, etc.); the difference was statistically significant. After implementing the tool, there was an improvement in the transfer of patient clinical data relevant to the safe continuity of care.

Manejo extrahospitalario de la fibrilación auricular y su Adecuación a las guías de práctica clínica

Objetivo: Estudiar la variabilidad del manejo de la fibrilación auricular (FA) por equipos de emergencias y su adherencia a las guías de tratamiento. Material y método. Estudio descriptivo de episodios de FA atendidos en dos años en Cádiz. Recogemos 236 pacientes. Analizamos antecedentes, actuación del equipo y resultados de control de frecuencia y ritmo. Construimos un índice sintético de adecuación terapéutica (ISAT) con rango de -3 a 3. Resultados. 236 pacientes, 68% varones, las mujeres más jóvenes (66 vs 75 años); 43.8% fueron primeros episodios. El fármaco más usado es la amiodarona. El 16,1% de las asistencias presentaron adherencia completa (ISAT 3) y el 63,1%, adecuación parcial positiva (ISAT 1-2); la mayor variabilidad clínica se produjo en la bradicardización. La adecuación fue: 62,3% para anticoagulación, 68.2% para bradicardización y 56.8% para cardioversión. Existió un 40,7% de control de frecuencia y un 96% de derivación hospitalaria. Conclusión. Debemos aumentar el porcentaje de anticoagulación y empleo de bloqueadores-beta y calcioantagonistas en sustitución de amiodarona. El ISAT permite mejorar la adecuación a las GPC que facilita controlar síntomas, frecuencia y reducir estancias en los servicios de urgencia.

An Ethical Pathway to Quality of Life in Critically Ill Newborns

Advances in perinatology have permitted the survival of fragile neonates. Quality of life (QoL) has been considered a key element in medical decision-making. In this review we analyse the role of QoL regarding the decision of withholding or withdrawing of life-sustaining treatment (LST). The role of QoL is debated because of the conceptual difficulties it raises. The lack of consensus on its definition and the difficulties in measuring it objectively, mean that basing clinical decisions solely on QoL has some risks. To avoid a purely subjective assessment, the principle of totality, and the principle of therapeutic adequacy should be considered. In case of uncertain prognosis, some therapeutic persistence seems reasonable. If this does not benefit the clinical condition of the child, then it may be no longer appropriate to continue the LST in case of severe disabilities. QoL is essential in medical decision-making, but is insufficient as the only criterion.

Visual hallucinations in parkinson’s disease: Experience from a portuguese level 3 hospital

IntroductionParkinson’s disease is a neurodegenerative pathology characterized by motor and non-motor symptoms. Hallucinations, especially visual ones, are frequent in this context, with an estimated prevalence of 16 to 40% and associated with a less favorable prognosis. These hallucinations can range from coarse formations to well-defined structures.ObjectivesTo assess the prevalence of visual hallucionations in a sample of patients diagnosed with Parkinson’s Disease.MethodsA cross-sectional descriptive study conducted in a Neurology Department of a Level III portuguese hospital. The sample included patients with Parkinson’s Disease observed in an outpatient Neurology appointment between October 1 and December 9, 2019.ResultsIn the period considered, 100 patients with Parkinson’s disease were observed, 65% male, with an average age of 69 years. In 11% of the patients visual hallucinations were reported, of which about half were well defined. All of them had no previous history of visual hallucinations and were under dopaminergic medication.ConclusionsThe results show an inferior prevalence when comparing to the literature, albeit still frequent. Therapeutic adequacy has a well recognised impact at a functional level and prognosis. Therefore we stress the importance of a regular follow-up of these patients, recommending a rigorous and comprehensive clinical review.

Interleukin-6: A Versatile Biomarker in the Clinical Chemistry Laboratory in the COVID-19 Era

Introduction: Interleukin-6 (IL-6) is a proinflammatory cytokine released during the cytokine storm of sepsis and Coronavirus Disease-2019 (COVID-19). IL-6 has been extensively used as a biomarker in Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) and in the emerging novel paediatric disease called Paediatric Inflammatory Multisystem Syndrome-temporarily associated with SARS-CoV-2 (PIMS-TS) or Multisystem Inflammatory Syndrome in Children (MIS-C). Additionally, IL-6 measurement is necessary to decide for several cytokine-blocking and cytokine-removal therapies and to determine treatment adequacy. Aim: Evaluation of the performance of IL-6 in COVID-19, PIMS-TS/MIS-C and in CytoSorb cytokine removal therapy in sepsis as a versatile biomarker in clinical chemistry laboratory. Materials and Methods: The study was an exploratory descriptive study carried out between March 2019 and February 2021 for a period of 24 months. IL-6 (pg/mL) was measured on Roche e411 immunoassay platform using Electrochemiluminiscence Assays (ECLIA) in 15 adult patients. Biological reference interval of the parameter was &lt;7 pg/mL. Results: The results showed that IL-6 was increased significantly in non survivors compared to survivors with COVID-19 (p-value=0.0043). IL-6 levels (normal &lt;7 pg/mL) were highly elevated in children with PIMS-TS {median 75.9 pg/mL (IQR: 47.3-223.4)} reflecting the intense inflammatory state of the novel paediatric condition. All PIMS-TS cases (n=13) survived. IL-6 levels were increased post CytoSorb therapy in sepsis patients who did not survive and declined in survivors. IL-6 serially measured during treatment helped to monitor therapeutic adequacy in prolonged sepsis case. Conclusion: The various applications of automated IL-6 testing in the clinical chemistry laboratory reflects the versatility of the trending biomarker.

Screening and evaluation of Terminalia catappa and its compound application

Plant determined medications remains an important source, particularly in creating countries, to look at genuine sicknesses roughly 62-80% of the total populace although everything depends on conventional medication for the therapy of specific disease. Indeed, plants produce a various scope of bioactive atoms creation them an ironic wellspring of an alternate kind of drugs. There are hardly any reports and utilization of plants in conventional mending by either ancestral individuals or indigenous network. Rejuvenating plants are the wellspring of extraordinary monetary estimation of everywhere on over the world. Nature has the best word on us a rich plant riches, and an enormous number of assorted kinds of plants develop in various pieces of the nation. Homegrown medication is as yet a pillar of around 75 to 85% the entire populace and the significant aspect of the conventional therapy the utilization of the plant extricate and the dynamic constituents. Among the 7000 types of rejuvenating plants perceived everywhere on over the world in excess of 9000, valuable medicinal plants are found in India. Unfortunately, just not many of them are utilized for their therapeutic worth. Around 1500 plants systematically utilize the conventional arrangement of Indian medication. Notwithstanding, the ethanopharmacologist, microbiologist, botanist and common item physicist world over today, is continually still looking for therapeutic adequacy of the plants on the phytochemicals. Along these lines, the quest for the new phytochemical is the foremost significant important to research the primer phytochemical examination to Terminalia catappa and Syzygium jumbolanam.

Appropriateness of proton pump inhibitors treatment in clinical practice: Prospective evaluation in outpatients and perspective assessment of drug optimisation

BackgroundHigh rates of inappropriate proton pump inhibitor (PPI) prescriptions have been reported in retrospective database analyses. Assessing the appropriateness of long-term PPIs in outpatients, with a proactive approach at drug optimisation may enhance treatment adequacy. AimsTo describe the characteristics of outpatients who are on long-term PPIs, to assess the magnitude of inappropriate PPI prescriptions, and to evaluate the rate of drug optimisation following specialist recommendations. MethodsAppropriateness of long-term (>8weeks) PPI prescription was prospectively assessed in 249 consecutive patients referred to a Gastroenterology outpatient clinic. We recorded reason for prescription, dose, modality, duration of therapy, and attempts at PPI optimisation. ResultsPPIs were inappropriately prescribed in 96/249 patients (38.6%). Gastro-oesophageal reflux disease (50/143, 35.0%) and prophylaxis of anti-platelet/non-steroidal anti-inflammatory drugs (5/49, 10.2%) were the most common PPI indications and those with the lowest rate of inappropriateness, while the highest rates were observed for treatment of dyspepsia (10/12, 83.3%) and anti-coagulant therapy (21/21, 100%). PPI treatment was optimised in 112 patients (45.0%). ConclusionsPPIs are inappropriately used in about 40% of outpatients, reflecting scant attention to guidelines. A proactive approach may improve therapeutic adequacy in approximately half of patients. Educational efforts to guide PPI prescription should be further pursued.

400-P: High Levels of Glycemic Coefficient of Variation Are Associated with Higher Hypoglycemia Episodes in T1D Adults in a Brazilian Tertiary Hospital

People with type 1 diabetes (T1D) have a higher risk of hypoglycemia (H), especially in the presence of high glycemic excursion, increasing cardiovascular mortality. The coefficient of variation (CV) allows current assessment of glycemic control and therapeutic adequacy. This cross-sectional study investigated the associations among H episodes, CV, glycemic variability (GV), and T1D clinical and laboratory parameters. Sixty T1D patients aged ≥18 years and followed for at least six months in a Brazilian Public Tertiary Hospital were included. Three seven-point glycemic profiles were performed in consecutive days, totalizing 21 blood glucose tests. The indicators GV, standard deviation (SD)/glycemic mean (mg/dL) and CV, SD/glycemic mean were calculated from data record in the monitor. H was classified as H1:&amp;lt;70 and ≥54mg/dL and H2:&amp;lt;54mg/dL. Statistical analysis was performed with Spearman correlation and Mann-Whitney (p&amp;lt;0.05 was considered significant). Of all, 73.3% were women, aged 34.7 ± 2.3 years, T1D duration: 22.5 ± 9.7 years, HbA1c 8.8 ± 1.8%, GV 70.9 ± 25.9mg/dL (goal&amp;lt;50) and CV 42.8 ± 9.6% (goal&amp;lt;36%). H occurred in 76.7%, and H2 in 50% of T1D patients. H1 was positively correlated with CV (p&amp;lt;0.0001) and T1D duration (p&amp;lt;0.0271); negatively with mean of glycemia (p&amp;lt;0.0001), and glycemia above target (&amp;gt;180mg/dL) (p&amp;lt;0.0004). H2 was positively correlated with CV (p&amp;lt;0.0005); blood glucose below target (&amp;lt;70mg/dL) (p&amp;lt;0.0001), and reported weekly frequency of hypoglycemia (p&amp;lt;0.0470). T1D patients presented high VC and GV. Only CV had a significant correlation with H1 and H2 episodes. Education about quickly hypoglycemia treatment is highly required, mainly in the presence of asymptomatic episodes. Systematic glycemic monitoring and continuing education in diabetes, targeting insulin dose adjustments, glycemic goals, healthy food orientation, and physical activity may reduce life risks of this population. Disclosure T.B. Brasil: None. A.C. Sposito: None. B. Adachi: None. W.M. Volpini: None. E.J. Pavin: None.

A REVIEW ON HYDROTROPY: A POTENTIAL APPROACH FOR THE SOLUBILITY ENHANCEMENT OF POORLY SOLUBLE DRUG

Solubility is one of the significant parameters to accomplish wanted centralization of medication in foundational flow for pharmacological reaction to appear. Medication adequacy can be seriously constrained by poor watery dissolvability, and a few medications additionally show reactions because of their poor solvency. There are numerous strategies which are utilized to upgrade the fluid solvency. The capacity to increment watery solvency would thus be able to be a profitable guide to expanding proficiency as well as lessening reactions for specific medications. The ability to augment watery dissolvability would subsequently have the option to be a beneficial manual for extending capability just as diminishing responses for explicit medications. Therapeutic adequacy of a medication relies on the bioavailability and at last on the solvency of medication particles. Solvency is one of the significant parameters to accomplish wanted convergence of medication in fundamental course for pharmacological reaction to appear. Because of cutting edge inquire about and advancement, there are assortments of new medications and their subordinates are accessible. In any case, over 40% of lipophilic medication up-and-comers neglect to achieve showcase because of poor bioavailability, despite the fact that these medications may display potential pharmacodynamic exercises. The lipophilic medication that achieves market requires a high portion to accomplish appropriate pharmacological activity. Hydrotropy is one of the solvency improvement methods which upgrade dissolvability to numerous folds with utilization of hydrotropes such as sodium benzoate, sodium citrate, urea, niacinamide, and so forth and have numerous focal points as, it does not require substance alteration of hydrophobic medications, utilization of natural solvents, or readiness of emulsion framework and so forth.

Risk factors for mortality and cost implications of complicated intra-abdominal infections in critically ill patients

PurposeTo assess risk factors for 28-day mortality and cost implications in intensive care unit (ICU) patients with complicated intra-abdominal infections (cIAIs). MethodsSingle-center retrospective cohort study of prospectively collected data analysing ICU patients with a microbiologically confirmed complicated intra-abdominal infections. Results137 complicated intra-abdominal infections were included and stratified according to the adequacy of antimicrobial therapy (initial inadequate antimicrobial therapy [IIAT], n = 44; initial adequate antimicrobial therapy [IAAT], n = 93). The empirical use of enterococci/methicillin-resistant Staphylococcus aureus active agents and of carbapenems was associated with a higher rate of therapeutic adequacy (p = 0.016 and p = 0.01, respectively) while empirical double gram-negative and antifungal therapy did not.IAAT showed significantly lower mortality at 28 and 90 days and increased clinical cure and microbiological eradication (p < 0.01). In the logistic and Cox-regression models, IIAT and inadequate source control were the unique predictors of 28-day mortality.No costs differences were related to the adequacy of empirical therapy and source control. The empirical double gram-negative and antifungal therapy (p = 0.03, p = 0.04) as well as the isolation of multidrug-resistant (MDR) bacteria and the microbiological failure after targeted therapy were drivers of increased costs (p = 0.004, p = 0.04). ConclusionsIIAT and inadequate source control are confirmed predictors of mortality in ICU patients with complicated intra-abdominal infections. Empirical antimicrobial strategies and MDR may drive hospital costs.

Urine cultures and antibiotics for urinary tract infections in Dutch general practice.

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.