Variations in presentation, management, and patient outcomes of urinary tract infection: A prospective four-country primary care observational cohort study

Abstract

Aim: To describe presentation and management of urinary tract infection in primary care settings, and explore the association with patient recovery, taking microbiological findings and case mix into account. Design and setting: Prospective observational study of women with symptoms of uncomplicated UTI presenting to primary care networks in England, Wales, the Netherlands, and Spain. Method: Clinicians recorded history, symptom severity, management, and requested mid-stream urine culture. Participants recorded symptom severity each day for 14 days in a diary. Time to recovery was compared between patient characteristics and between countries using two-level Cox proportional hazards models, with patients nested within practices. Results: 797 women attending primary care networks in England (246 (30·9%)), Wales (213 (26·7%)), the Netherlands (133 (16·7%)) and Spain (205 (25·7%)) were included. 259 (35·7%, 95% CI 32·3 to 39·2) were urine culture positive for UTI. Pathogens and antibiotic sensitivities were similar. Empirical antibiotics were prescribed for > 90% of women in England, Wales and Spain, but lower in the Netherlands. There were no meaningful differences at a country network level before and after controlling for severity, prior UTIs, and antibiotic prescribing. Conclusion: Variation in presentation and management of uncomplicated UTI at a country primary care network level is clinically unwarranted and highlights lack of consensus concerning optimal symptom control and antibiotic .prescribing.

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Identifiers

ORCID for Nick Francis: orcid.org/0000-0001-8939-7312

ORCID for Michael Moore: orcid.org/0000-0002-5127-4509

ORCID for Paul Little: orcid.org/0000-0003-3664-1873

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