Urinary Tract Infections In General Practice Research Articles

Trends in urine sampling rates of general practice patients with suspected lower urinary tract infections in England, 2015–2022: a population-based study

ObjectivesInappropriate prescribing of antibiotics is a key driver of antimicrobial resistance. This study aimed to describe urine sampling rates and antibiotic prescribing for patients with lower urinary tract infections (UTIs)...

Patients’ Experiences, Expectations, Motivations, and Perspectives around Urinary Tract Infection Care in General Practice: A Qualitative Interview Study

While there are many alternatives to antibiotics for the symptomatic treatment of urinary tract infections (UTIs), their application in practice is limited. Among other things, general practitioners (GPs) often feel pressure from patients to prescribe antibiotics. To gain a better understanding of why this happens and where this pressure originates from, we investigated experiences, expectations, motivations, and perspectives of patients with UTIs in general practice. During this qualitative study we performed 14 semi-structured online interviews among female UTI patients in general practice. Interviews were based on a topic list derived from sensitising concepts. All the interviews were recorded, transcribed, and analysed using a constant comparative technique. Three main categories emerged from the data; (1) experienced versus unexperienced patients with UTI, (2) patient's lack of knowledge, and (3) patients feeling understood. Inexperienced patients consult a general practitioner for both diagnosis and symptom relief, while experienced patients seem to consult specifically to obtain antibiotics. In addition, patients have a lack of knowledge with regard to the diagnosis, treatment, self-care, and cause of UTIs. Finally, patients' satisfaction is increased by involving them more in the process of decision making, so they feel understood and taken seriously. Patients' expectations in UTI management in general practice often arise during their first experience(s) and play a major role in subsequent episodes. In conclusion, preventing misconceptions is especially important in the inexperienced patient group, as this may prevent future overtreatment of UTIs. In addition, involving patients in the decision making process will lead to greater understanding of the GP's treatment choices.

Diagnosis and Antibiotic Treatment of Urinary Tract Infections in Danish General Practice: A Quality Assessment.

Rational antibiotic treatment of urinary tract infections (UTI) is important. To improve the quality of antibiotic treatment of UTI, it is essential to obtain insight into diagnostic approaches and prescribing patterns in general practice. The aim of this study was to investigate the quality of diagnostics and treatment of UTI in general practice by means of quality indicators (QIs). QIs provide a quantitative measure of quality and are defined by a numerator (the number of patients receiving a specific investigation or treatment) and a denominator (the number of patients included in the quality assessment). For adult patients with suspected UTI, practices registered the following: age, sex, risk factors, symptoms and signs, examinations, diagnosis and treatment. The levels of the QIs were compared with their corresponding standards. Half of the patients diagnosed with lower UTI or pyelonephritis fulfilled the diagnostic criteria for UTI: characteristic UTI symptoms and clear signs of bacteriuria, respectively. Urinalysis was performed for nearly all patients, including patients without characteristic symptoms of UTI. One-fourth of the patients with suspected lower UTI were treated with antibiotics despite no urinalysis and nearly half received antibiotics despite an inconclusive dipstick test. Pivmecillam was the preferred antibiotic. The findings of this study indicate that there is room for improvement in the management of UTI in Danish general practice.

Antimicrobial resistance inE. Coli associated with urinary tract infection in the West of Ireland

Knowledge of antimicrobial resistance patterns in E. coli, the predominant pathogen associated with urinary tract infection (UTI) is important as a guide in selecting empirical antimicrobial therapy To describe the antimicrobial susceptibility of E. coli associated with UTI in a region in the West of Ireland. A collection of 934 E. coli isolates associated with UTI were tested for susceptibility to a panel of antimicrobial agents by the disc diffusion method of the National Committee for Clinical Laboratory Standards. More than 50% of E. coli were resistant to ampicillin, more than 40% resistant to sulphonamide and more than 30% resistant to trimethoprim. From 7.9% (community) to 12.5% (hospital) are resistant to co-amoxiclav with approximately 20% of isolates of intermediate susceptibility. In general practice most E. coli remain susceptible to nitrofurantoin (96.7%), nalidixic acid (93.9%) and ciprofloxacin (94.7%). For all agents rates of resistance were higher in hospital as compared with general practice isolates. Three isolates with the phenotype of Extended Spectrum Beta-lactamase (ESBL) resistance were detected. Ampicillin/amoxicillin are not suitable for empiric therapy of UTI in general practice or hospital patients in this region. There is doubt as to the role of trimethorpim or co-trimoxazole for empiric therapy of UTI. Nitrofurantoin, nalidixic acid and ciprofloxacin are active against the great majority of UTI associated E. coli.

Management of urinary tract infections in primary care: a repeated 1-week diagnosis-prescribing study in five counties in Sweden in 2000 and 2002.

A diagnosis-antibiotic prescribing study was performed in 5 counties in Sweden during 1 week in November in the y 2000 and 2002, respectively. As part of the study, the characteristics and clinical management of patients who received diagnoses of urinary tract infections (UTIs) (n = 1564) in primary care, were analysed. 85% of the visits were by women, and 74% of all consultations were diagnosed as lower UTIs. One or more diagnostic tests were performed in 98% of the women with suspected lower or recurrent UTIs and 95% were prescribed an antibiotic. The most commonly prescribed antibiotics for lower UTIs were trimethoprim followed by pivmecillinam and a quinolone. The study indicated a change in antibiotic prescribing with improved adherence to the national recommendations. There was an increase of prescribed nitrofurantoin and a decrease of prescribed quinolones to women with lower UTIs between the studied y. Furthermore, 3-d treatment with trimethoprim increased although the prescribed duration was mostly 7 d. In contrast to the guidelines, few urine cultures were performed. The study highlights the necessity of updating the guidelines for the management of lower UTIs in general practice.

Urinary-tract Infection in General Practice

In three studies, 616 patients (610 female and six male) presented with symptoms suggesting urinary tract infection (UTI). Of these, 321 had greater than 100 X 10(6) bacteria per litre in a midstream urine sample. None of the presenting symptoms could be considered to be a reliable indicator of bacteriuria. Ninety percent of infected urines and 44 percent of uninfected urines had a raised white cell concentration. Escherichia coli was the most common infecting organism (71.3 percent). Next were Gram positive cocci at 15.6 percent, Proteus mirabilis (7.5 percent), and Klebsiella-Enterobacter species (0.7 percent). At follow-up over 30 days 25.6 percent of patients initially infected again had infected urine. The organisms isolated from initial MSUs were sensitive to most antibacterial agents by disc-sensitivity testing. The expected urine levels of drugs used in the study greatly exceeded the measured minimum inhibitory concentration.

DIAGNOSIS OF URINARY-TRACT INFECTION IN GENERAL PRACTICE

The diagnosis of urinary-tract infection in general practice has been assessed with the aid of suprapubic aspiration and the dip-slide technique. Using a laboratory pour-plate method as the criteria of infection it has been found that a combination of suprapubic aspiration and the dip-slide culture confirmed the presence of infection in 92% of cases, direct microscopy of this suprapubic aspirate in 73%, and culture of a single midstream sample of urine in 72%. Suprapubic aspiration was safe and reliable in general practice, and was tolerated well by patients. It is suggested that the diagnosis of a urinary infection in general practice can best be made by the dip-slide inoculation of a suprapubic aspirate of urine.

Site of infection in acute urinary-tract infection in general practice

<h2>Summary</h2> The site of infection has been determined by the bladder-washout technique in 78 women presenting to their general practitioners with symptoms suggesting acute urinary tract infection. In 55 patients the urine contained 10,000 or more organisms per ml. in a midstream specimen. Infection was confirmed by a catheter' specimen in all 50 who returned for further testing. In half the patients in whom the bladder urine was infected the infection was confined to the bladder; in the other half it was renal in origin. There was a poor correlation between the symptoms and signs and the site of infection; but signs such as loin pain, temperature, rigors, and nausea and vomiting were more likely to occur in renal infection than in bladder infection. Symptoms usually regarded as evidence of bladder infection, such as frequency, burning, and suprapubic pain, were often the only symptoms in patients with proven renal infection. The site of infection was renal in most <i>Proteus</i> spp. infections. Raised serum-antibody titres were of no value in assessing the site of infection in these patients.