Cost Effective Use of Urine Sampling and Dipstick Testing to Diagnose Urinary Tract Infections in Pre-School Children Presenting to Primary Care

Abstract Background Uncomplicated urinary tract infections (UTIs) should be treated empirically with a short course of narrow-spectrum antibiotics. However, many clinicians order unnecessary tests and treat with long courses of antibiotics. The objective of this study was to understand how internists clinically approach UTIs. Methods We conducted semi-structured qualitative interviews of community primary care providers (n = 15) and internal medicine residents (n = 15) in St. Louis, Missouri from 2018 to 2019 to explore why clinical practices deviate from evidence-based guidelines. Interviews were transcribed, de-identified, and coded by two independent researchers using NVivo qualitative software. A Likert scale was used to evaluate preferences for possible interventions. Results Several common themes emerged. Both providers and residents ordered urine tests to “confirm” presence of urinary tract infections. Antibiotic prescriptions were often based on historical practice and anecdotal experience. Providers were more comfortable treating over the phone than residents and tended to prescribe longer courses of antibiotics. Both providers and residents voiced frustrations with guidelines being difficult to easily incorporate due to length and extraneous information. Preferences for receiving and incorporating guidelines into practice varied. Both groups felt benchmarking would improve prescribing practices, but had reservations about implementation. Pragmatic clinical decision support tools were favored by providers, with residents preferring order sets and attendings preferring nurse triage algorithms. Conclusion Misconceptions regarding urinary tract infection management were common among residents and community primary care providers. Multifaceted interventions that include provider education, synthesis of guidelines, and pragmatic clinical decision support tools are needed to improve antibiotic prescribing and diagnostic testing; optimal interventions to improve UTI management may vary based on provider training level. Disclosures All authors: No reported disclosures.

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Uncomplicated urinary tract infections in Swedish primary care; etiology, resistance and treatment

BMC Infectious Diseases ◽

10.1186/s12879-019-3785-x ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 6

Author(s):

Helena Kornfält Isberg ◽

Eva Melander ◽

Katarina Hedin ◽

Sigvard Mölstad ◽

Anders Beckman

Keyword(s):

Primary Care ◽

Urinary Tract ◽

Urinary Tract Infections ◽

Tract Infections

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Diagnosis, prevention and control of urinary tract infections: a survey of routine practices in Belgian nursing homes

Journal of Infection Prevention ◽

10.1177/1757177420921914 ◽

2020 ◽

Vol 21 (5) ◽

pp. 182-188

Author(s):

Katrien Latour ◽

Jan De Lepeleire ◽

Béatrice Jans ◽

Frank Buntinx ◽

Boudewijn Catry

Keyword(s):

Urinary Tract ◽

Nursing Homes ◽

Urinary Tract Infections ◽

Prevention And Control ◽

Urinary Catheter ◽

Infection Prevention And Control ◽

Urine Sampling ◽

Tract Infections ◽

And Control ◽

Catheter Care

Background: Urinary tract infections (UTIs) are one of the most frequently reported infections in older adults and the most common reason for antimicrobial prescribing in nursing homes (NHs). In this vulnerable population, both a good diagnosis and prevention of these infections are crucial as overuse of antibiotics can lead to a variety of negative consequences including the development of multidrug-resistant organisms. Objective: To determine infection prevention and control (IPC) and diagnostic practices for UTIs in Belgian NHs. Methods: Local staff members had to complete an institution-level questionnaire exploring the availability of IPC practices and resources and procedures for UTI surveillance, diagnosis, and urinary catheter and incontinence care. Results: UTIs were the second most common infections in the 87 participating NHs (prevalence: 1.0%). Dipstick tests and urine cultures were routinely performed in 30.2% and 44.6% of the facilities, respectively. In non-catheterised residents, voided or midstream urine sampling was most frequently applied. Protocols/guidelines for urine sampling, urinary catheter care and incontinence care were available in 43.7%, 45.9% and 31.0% of the NHs, respectively. Indwelling catheters were uncommon (2.3% of the residents) and urinary retention (84.9%) and wound management (48.8%) were the most commonly reported indications. Only surveillance was found to significantly impact the UTI prevalence: 2.2% versus 0.8% in NHs with or without surveillance, respectively ( P < 0.001). Discussion: This survey identified key areas for improving the diagnosis and prevention of UTIs, such as education and training regarding the basics of urine collection and catheter care.

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Lower Urinary Tract Infections: Management, Outcomes and Risk Factors for Antibiotic Re-prescription in Primary Care

EClinicalMedicine ◽

10.1016/j.eclinm.2019.07.012 ◽

2019 ◽

Vol 14 ◽

pp. 23-31 ◽

Cited By ~ 2

Author(s):

Mar Pujades-Rodriguez ◽

Robert M. West ◽

Mark H. Wilcox ◽

Jonathan Sandoe

Keyword(s):

Risk Factors ◽

Primary Care ◽

Urinary Tract ◽

Urinary Tract Infections ◽

Lower Urinary Tract ◽

Tract Infections ◽

Lower Urinary

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Does cranberry extract reduce antibiotic use for symptoms of acute uncomplicated urinary tract infections (CUTI)? Protocol for a feasibility study

Trials ◽

10.1186/s13063-019-3860-z ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Oghenekome Gbinigie ◽

Julie Allen ◽

Anne-Marie Boylan ◽

Alastair Hay ◽

Carl Heneghan ◽

...

Keyword(s):

Primary Care ◽

Urinary Tract ◽

Feasibility Study ◽

Urinary Tract Infections ◽

Treatment Options ◽

Sample Size Calculation ◽

Antibiotic Use ◽

Primary Objective ◽

Feasibility Trial ◽

Tract Infections

Abstract Background Consultations in primary care for symptoms of urinary tract infections (UTIs) are common and patients are frequently treated with antibiotics. Given increasing antimicrobial resistance, there has been interest in non-antibiotic treatment options for common infections. One such option is the use of cranberry extract to treat symptoms attributable to UTIs. Methods A target of 45 women consulting in primary care, with symptoms suggestive of an uncomplicated UTI for whom the practitioner would normally prescribe antibiotics, will be randomised to receive one of three treatment approaches: (1) immediate prescription for antibiotics; (2) immediate prescription for antibiotics plus a 7-day course of cranberry capsules and (3) cranberry capsules plus a delayed prescription for antibiotics to be used in case their symptoms do not get better, or get worse. Follow-up will be by daily rating of symptoms and recording of treatments used for 2 weeks in an online symptom diary. Interviews will be conducted with around 10–15 study participants, as well as with around 10–15 women who have experienced a UTI but have not been approached to take part in the study. Both groups will be asked about their experience of having a UTI, their thoughts on non-antibiotic treatments for UTIs and their thoughts on, or experience of, the feasibility trial. The primary objective is to assess the feasibility of undertaking a full trial in primary care of the effectiveness of cranberry extract to reduce antibiotic use for symptoms of acute uncomplicated UTI. The secondary objective is to conduct a preliminary assessment of the extent to which cranberry might reduce antibiotic use and symptom burden. Discussion This feasibility study with embedded interviews will inform the planning and sample size calculation of an adequately powered trial to definitively determine whether cranberry helps to alleviate the symptoms of acute uncomplicated UTIs in women and whether it can safely reduce antibiotic use. Trial registration ISRCTN registry, ID: 10399299. Registered on 24 January 2019.

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