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Point-of-care urine culture for managing urinary tract infection in primary care: A randomised controlled trial of clinical and cost-effectiveness

Point-of-care urine culture for managing urinary tract infection in primary care: A randomised controlled trial of clinical and cost-effectiveness
Point-of-care urine culture for managing urinary tract infection in primary care: A randomised controlled trial of clinical and cost-effectiveness

Background The effectiveness of using point-of-care (POC) urine culture in primary care on appropriate antibiotic use is unknown. Aim To assess whether use of the Flexicult™ SSIUrinary Kit, which quantifies bacterial growth and determines antibiotic susceptibility at the point of care, achieves antibiotic use that is more often concordant with laboratory culture results, when compared with standard care. Design and setting Individually randomised trial of females with uncomplicated urinary tract infection (UTI) in primary care research networks (PCRNs) in England, the Netherlands, Spain, and Wales. Method Multilevel regression compared outcomes between the two groups while controlling for clustering. Results In total, 329 participants were randomised to POC testing (POCT) and 325 to standard care, and 324 and 319 analysed. Fewer females randomised to the POCT arm than those who received standard care were prescribed antibiotics at the initial consultation (267/324 [82.4%] versus 282/319 [88.4%], odds ratio [OR] 0.56, 95% confidence interval [CI] = 0.35 to 0.88). Clinicians indicated the POCT result changed their management for 190/301 (63.1%). Despite this, there was no statistically significant difference between study arms in antibiotic use that was concordant with laboratory culture results (primary outcome) at day 3 (39.3% POCT versus 44.1% standard care, OR 0.84, 95% CI = 0.58 to 1.20), and there was no evidence of any differences in recovery, patient enablement, UTI recurrences, re-consultation, antibiotic resistance, and hospitalisations at follow-up. POCT culture was not cost-effective. Conclusion Point-of-care urine culture was not effective when used mainly to adjust immediate antibiotic prescriptions. Further research should evaluate use of the test to guide initiation of 'delayed antibiotics'.

Antimicrobial drug resistance, Bacterial infections, Cost-benefit analysis, Drug resistance, Point-of-care testing, Urinary tract infections
0960-1643
e268-e278
Butler, Christopher C.
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Francis, Nick A.
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Thomas-Jones, Emma
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Longo, Mirella
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Wootton, Mandy
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Llor, Carl
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Little, Paul
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Moore, Michael
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Bates, Janine
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Pickles, Timothy
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Kirby, Nigel
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Gillespie, David
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Rumsby, Kate
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Brugman, Curt
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Gal, Micaela
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Hood, Kerenza
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Verheij, Theo
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Butler, Christopher C.
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Francis, Nick A.
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Thomas-Jones, Emma
ea15d5ac-8232-4823-ab40-17bec0968520
Longo, Mirella
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Wootton, Mandy
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Llor, Carl
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Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Moore, Michael
1be81dad-7120-45f0-bbed-f3b0cc0cfe99
Bates, Janine
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Pickles, Timothy
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Kirby, Nigel
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Gillespie, David
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Rumsby, Kate
2002ee8a-32ac-4119-869d-ed35164c3b51
Brugman, Curt
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Gal, Micaela
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Hood, Kerenza
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Verheij, Theo
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Butler, Christopher C., Francis, Nick A., Thomas-Jones, Emma, Longo, Mirella, Wootton, Mandy, Llor, Carl, Little, Paul, Moore, Michael, Bates, Janine, Pickles, Timothy, Kirby, Nigel, Gillespie, David, Rumsby, Kate, Brugman, Curt, Gal, Micaela, Hood, Kerenza and Verheij, Theo (2018) Point-of-care urine culture for managing urinary tract infection in primary care: A randomised controlled trial of clinical and cost-effectiveness. British Journal of General Practice, 68 (669), e268-e278. (doi:10.3399/bjgp18X695285).

Record type: Article

Abstract

Background The effectiveness of using point-of-care (POC) urine culture in primary care on appropriate antibiotic use is unknown. Aim To assess whether use of the Flexicult™ SSIUrinary Kit, which quantifies bacterial growth and determines antibiotic susceptibility at the point of care, achieves antibiotic use that is more often concordant with laboratory culture results, when compared with standard care. Design and setting Individually randomised trial of females with uncomplicated urinary tract infection (UTI) in primary care research networks (PCRNs) in England, the Netherlands, Spain, and Wales. Method Multilevel regression compared outcomes between the two groups while controlling for clustering. Results In total, 329 participants were randomised to POC testing (POCT) and 325 to standard care, and 324 and 319 analysed. Fewer females randomised to the POCT arm than those who received standard care were prescribed antibiotics at the initial consultation (267/324 [82.4%] versus 282/319 [88.4%], odds ratio [OR] 0.56, 95% confidence interval [CI] = 0.35 to 0.88). Clinicians indicated the POCT result changed their management for 190/301 (63.1%). Despite this, there was no statistically significant difference between study arms in antibiotic use that was concordant with laboratory culture results (primary outcome) at day 3 (39.3% POCT versus 44.1% standard care, OR 0.84, 95% CI = 0.58 to 1.20), and there was no evidence of any differences in recovery, patient enablement, UTI recurrences, re-consultation, antibiotic resistance, and hospitalisations at follow-up. POCT culture was not cost-effective. Conclusion Point-of-care urine culture was not effective when used mainly to adjust immediate antibiotic prescriptions. Further research should evaluate use of the test to guide initiation of 'delayed antibiotics'.

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BUtler POETIC TRIAL BJGP_ - Accepted Manuscript
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Accepted/In Press date: 26 October 2017
e-pub ahead of print date: 28 March 2018
Published date: 1 April 2018
Keywords: Antimicrobial drug resistance, Bacterial infections, Cost-benefit analysis, Drug resistance, Point-of-care testing, Urinary tract infections

Identifiers

Local EPrints ID: 420506
URI: https://eprints.soton.ac.uk/id/eprint/420506
ISSN: 0960-1643
PURE UUID: 0778df7f-e9b4-4f93-985e-414ab032ff22
ORCID for Michael Moore: ORCID iD orcid.org/0000-0002-5127-4509
ORCID for Kate Rumsby: ORCID iD orcid.org/0000-0002-8573-3718

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Date deposited: 09 May 2018 16:30
Last modified: 14 Mar 2019 01:50

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Contributors

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

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