Management of urinary tract infection by early-career general practitioners in Australia.
antibacterial agents
cross-sectional studies
general practitioners
prevalence
urinary tract infections
Journal
Journal of evaluation in clinical practice
ISSN: 1365-2753
Titre abrégé: J Eval Clin Pract
Pays: England
ID NLM: 9609066
Informations de publication
Date de publication:
Dec 2020
Dec 2020
Historique:
received:
16
09
2019
revised:
03
12
2019
accepted:
06
12
2019
pubmed:
26
12
2019
medline:
30
6
2021
entrez:
26
12
2019
Statut:
ppublish
Résumé
Urinary tract infection (UTI) is a common presentation to general practitioners (GPs). There is increasing antimicrobial resistance in urinary pathogens in many healthcare systems. Adherence to principles of antimicrobial stewardship is important to combat this problem. Our aim was to describe the prevalence of presentations of clinically diagnosed new UTI to early-career GPs, to describe management choices made, and to identify associations of prescribing antibiotics at the index consultation for UTI. This is a cross-sectional analysis of the Registrar Clinical Encounters in Training cohort study. Early-career GPs from five Australian states (urban to very remote practices) collected data on 60 consecutive patient encounters during each of three 6-month training terms. Proportions of problems being new UTIs, antibiotics prescribed, urine microscopy and culture ordered were calculated. Univariate and multivariable logistic regressions established associations of patient, registrar, and practice factors with prescribing antibiotics for a new UTI. One thousand three hundred thirty-three early-career GPs diagnosed 2850 new UTIs from 189 736 consultations (1.5%; 95% CI, 1.4-1.6). Antibiotics were prescribed at 86% (95% CI, 84.7-87.2) of these index consultations. Antibiotic choice followed Australian therapeutic guideline recommendations. Urine microscopy and culture were requested at the index consultation less than recommended by guidelines in men, 69.2% (95% CI, 62.6-75.1), and children, 80.8% (95% CI, 76.4-84.6). Adults were significantly more likely to be treated with antibiotics at the index consultation than children under 16. A new UTI is a common presentation to Australian early-career GPs. There is general adherence to guidelines for antibiotic choice in UTIs. Further research is needed, however, to understand some decisions made when managing UTI in children and men. This may reflect diagnostic uncertainty with consequent attention to antibiotic stewardship by deferring antibiotic prescription.
Substances chimiques
Anti-Bacterial Agents
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1703-1710Subventions
Organisme : This work was supported by government funding as follows. During the data collection period included in this study, funding of the ReCEnT study was by the participating educational organizations: General Practice Training Valley to Coast, the Victorian Metropolitan Alliance, General Practice Training Tasmania, Tropical Medical Training, and Adelaide to Outback GP Training Program (2010-2015). These organizations were funded by the Australian Department of Health. During 2016-18, the ReCEnT study was funded by an Australian Commonwealth Department of Health Research Grant and supported by GP Synergy, the general practice Regional Training Organization for New South Wales and the Australian Capital Territory. GP Synergy is funded by the Australian Department of Health.
Informations de copyright
© 2019 John Wiley & Sons, Ltd.
Références
Britt H, Miller GC, Henderson J, et al. General practice activity in Australia 2015-16. General practice series no. 40. Sydney 2016.
Foxman B. Urinary tract infection syndromes: occurrence, recurrence, bacteriology, risk factors, and disease burden. Infect Dis Clin North Am. 2014;28(1):1-13.
Fasugba O, Mitchell BG, Mnatzaganian G, Das A, Collignon P, Gardner A. Five-year antimicrobial resistance patterns of urinary Escherichia coli at an Australian tertiary hospital: time series analyses of prevalence data. PLoS One. 2016;11(10):e0164306.
Kahlmeter G. An international survey of the antimicrobial susceptibility of pathogens from uncomplicated urinary tract infections: the ECO.SENS Project. Journal of Antimicrobial Chemotherapy. 2002;51(1):69-76.
Malmartel A, Ghasarossian C. Epidemiology of urinary tract infections, bacterial species and resistances in primary care in France. Eur J Clin Microbiol Infect Dis. 2016;35(3):447-451.
Bleidorn J, Hummers-Pradier E, Schmiemann G, Wiese B, Gágyor I. Recurrent urinary tract infections and complications after symptomatic versus antibiotic treatment: follow-up of a randomised controlled trial. GMS German Medical Science. 2016;14.
Gagyor I, Bleidorn J, Kochen MM, Schmiemann G, Wegscheider K, Hummers-Pradier E. Ibuprofen versus fosfomycin for uncomplicated urinary tract infection in women: randomised controlled trial. BMJ. 2015;351:h6544.
Kronenberg A, Butikofer L, Odutayo A, et al. Symptomatic treatment of uncomplicated lower urinary tract infections in the ambulatory setting: randomised, double blind trial. BMJ. 2017;359:j4784.
Gharbi M, Drysdale JH, Lishman H, et al. Antibiotic management of urinary tract infection in elderly patients in primary care and its association with bloodstream infections and all cause mortality: population based cohort study. BMJ. 2019;364:l525.
Dawson-Hahn EE, Mickan S, Onakpoya I, et al. Short-course versus long-course oral antibiotic treatment for infections treated in outpatient settings: a review of systematic reviews. Fam Pract. 2017;34(5):511-519.
Little P, Moore MV, Turner S, et al. Effectiveness of five different approaches in management of urinary tract infection: randomised controlled trial. BMJ. 2010;340:c199.
eTG Complete. Urinary Tract Infections [Internet]. https://tgldcdp.tg.org.au/viewTopic?topicfile=urinary-tract-infections&guidelineName=Antibiotic#toc_d1e751.
Bjornsdottir I, Kristinsson KG, Hansen EH. Diagnosing infections: a qualitative view on prescription decisions in general practice over time. Pharm World Sci. 2010;32(6):805-814.
Morgan S, Magin PJ, Henderson KM, et al. Study protocol: the Registrar Clinical Encounters in Training (ReCEnT) study. BMC Fam Pract. 2012;13:50.
World Health Organisation. International Classification of Primary Care, Second edition (ICPC-2) [Internet]. 2003 [Available from: http://www.who.int/classifications/icd/adaptations/icpc2/en/.
WHO Collaborating Centre for Drug Statistics Methodology. Anatomical Therapeutic Chemical (ATC) classification system. Structure and principles. http://www.whocc.no/atc/structure_and_principles/.
Australian Standard Geographical Classification (ASGC) 2006. at http://www.abs.gov.au/AUSSTATS/abs@.nsf/Latestproducts/1AE106C101420508CA2571A900170741: (accessed 8/6/15). 2006.
AustralianBureauofStatistics. 2039.0-Information Paper: An Introduction to Socio-economic Indexes of Areas (SEIFA), 2006. Available at: http://www.abs.gov.au/ausstats/abs@.nsf/mf/2039.0/ [accessed 8/6/15]. 2006.
Bonevski B, Magin P, Horton G, Foster M, Girgis A. Trialling two recruitment strategies for improving response rates in general practitioner surveys: mission impossible. Aust Fam Physician. 2011;40:427-430.