The University of Southampton
University of Southampton Institutional Repository

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

Variations in presentation, management, and patient outcomes of urinary tract infection: A prospective four-country primary care observational cohort study
Variations in presentation, management, and patient outcomes of urinary tract infection: A prospective four-country primary care observational cohort study
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.
0960-1643
e830-e841
Butler, Christopher C. Butler
213e06ec-d3b4-412c-b503-ddad95794ebc
Francis, Nick A.
4fef3cf0-2dda-4294-bde7-e29eb33bbfdc
Thomas-Jones, Emma
ea15d5ac-8232-4823-ab40-17bec0968520
Llor, Carl
a7fcfced-28f4-4771-8ca5-2c1ce2095d61
Bongard, Emily J.
498cda67-5b1a-4f3a-98f1-9c2b01c48410
Moore, Michael
1be81dad-7120-45f0-bbed-f3b0cc0cfe99
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Bates, Janine
290a69e6-4f81-4dbe-b270-30e4155ca576
Lau, Mandy
828a2963-4975-4b74-8582-8b7cb3b961c1
Pickles, Timothy
d6ba6e68-3426-407e-93b2-04b588365fe3
Gal, Micaela
2d266726-f171-4a55-a381-29c5a2e42ec1
Wootton, Mandy
d0cbb02c-9039-42f8-98d1-62d741bd42e5
Kirby, Nigel
f096d265-c00e-42e0-8cd8-fb5ab470f513
Gillespie, David
a1389d8b-011c-408e-8064-2ce4ccf3312a
Rumsby, Kate
dd9f1fe4-f17b-4a93-9e28-17104eab5b38
Brugman, Curt
98f05a3f-4300-4937-99f2-e93441515d5b
Hood, Kerenza
62906d76-4931-4b12-9a64-0c867c7b84c1
Verheij, Theo J.M.
817a26b8-7db9-4e79-b00e-c0457f19f236
Butler, Christopher C. Butler
213e06ec-d3b4-412c-b503-ddad95794ebc
Francis, Nick A.
4fef3cf0-2dda-4294-bde7-e29eb33bbfdc
Thomas-Jones, Emma
ea15d5ac-8232-4823-ab40-17bec0968520
Llor, Carl
a7fcfced-28f4-4771-8ca5-2c1ce2095d61
Bongard, Emily J.
498cda67-5b1a-4f3a-98f1-9c2b01c48410
Moore, Michael
1be81dad-7120-45f0-bbed-f3b0cc0cfe99
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Bates, Janine
290a69e6-4f81-4dbe-b270-30e4155ca576
Lau, Mandy
828a2963-4975-4b74-8582-8b7cb3b961c1
Pickles, Timothy
d6ba6e68-3426-407e-93b2-04b588365fe3
Gal, Micaela
2d266726-f171-4a55-a381-29c5a2e42ec1
Wootton, Mandy
d0cbb02c-9039-42f8-98d1-62d741bd42e5
Kirby, Nigel
f096d265-c00e-42e0-8cd8-fb5ab470f513
Gillespie, David
a1389d8b-011c-408e-8064-2ce4ccf3312a
Rumsby, Kate
dd9f1fe4-f17b-4a93-9e28-17104eab5b38
Brugman, Curt
98f05a3f-4300-4937-99f2-e93441515d5b
Hood, Kerenza
62906d76-4931-4b12-9a64-0c867c7b84c1
Verheij, Theo J.M.
817a26b8-7db9-4e79-b00e-c0457f19f236

Butler, Christopher C. Butler, Francis, Nick A., Thomas-Jones, Emma, Llor, Carl, Bongard, Emily J., Moore, Michael, Little, Paul, Bates, Janine, Lau, Mandy, Pickles, Timothy, Gal, Micaela, Wootton, Mandy, Kirby, Nigel, Gillespie, David, Rumsby, Kate, Brugman, Curt, Hood, Kerenza and Verheij, Theo J.M. (2017) Variations in presentation, management, and patient outcomes of urinary tract infection: A prospective four-country primary care observational cohort study. British Journal of General Practice, 67 (665), e830-e841. (doi:10.3399/bjgp17X693641).

Record type: Article

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.

Text
POETIC Stage 2 observational UTI study 27.04.17 - Accepted Manuscript
Download (258kB)

More information

In preparation date: 2017
Accepted/In Press date: 28 April 2017
e-pub ahead of print date: 20 November 2017
Organisations: Primary Care & Population Sciences

Identifiers

Local EPrints ID: 408014
URI: https://eprints.soton.ac.uk/id/eprint/408014
ISSN: 0960-1643
PURE UUID: 1836db35-304d-42c9-8aac-f261015a0cae
ORCID for Michael Moore: ORCID iD orcid.org/0000-0002-5127-4509

Catalogue record

Date deposited: 09 May 2017 01:02
Last modified: 15 Aug 2019 04:52

Export record

Altmetrics

Contributors

Author: Christopher C. Butler Butler
Author: Nick A. Francis
Author: Emma Thomas-Jones
Author: Carl Llor
Author: Emily J. Bongard
Author: Michael Moore ORCID iD
Author: Paul Little
Author: Janine Bates
Author: Mandy Lau
Author: Timothy Pickles
Author: Micaela Gal
Author: Mandy Wootton
Author: Nigel Kirby
Author: David Gillespie
Author: Kate Rumsby
Author: Curt Brugman
Author: Kerenza Hood
Author: Theo J.M. Verheij

University divisions

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of https://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×