Urinary Tract Infections (UTI) in adult women in primary care: diagnosis, management and outcome across four EU countries (an observational study)
Urinary tract infections (UTI) are the most frequent bacterial infection affecting women and account for about 15% of antibiotics prescribed in primary care. However, some women with a UTI are not prescribed antibiotics or are prescribed the wrong antibiotics, while many women who do not have a microbiologically confirmed UTI are prescribed antibiotics. Inappropriate antibiotic prescribing unnecessarily increases the risk of side effects and the development of antibiotic resistance, and wastes resources.
Adult women presenting with suspected uncomplicated UTI were identified in general practices in England, the Netherlands, Spain and Wales. Data was collected on presentation and GP management and a urine sample taken for microbiological culture. Women were followed up for 2 weeks using a daily diary to record symptoms.Prevalence of microbiologically confirmed UTI (MC-UTI) in each country was estimated as well as prescribing and time to recovery. Multi-level regression analyses were undertaken to look at factors associated with microbiologically confirmed UTI, antibiotic prescribing and duration of illness.
797 women were recruited with 726 urine culture results. 35.7% participants were identified with a MC-UTI (95% CI 32.3 to 39.2). This varied across countries: Wales (24.1%) and England (24.3%), 77 in Spain (42.3%) and 81 in The Netherlands (63.8%). MC-UTI was associated with positive nitrites dipstick test (OR: 3.42, p<0.001) and cloudy urine (OR: 2.48, p<0.001).88.5% of participants were prescribed an antibiotic (95% CI: 86.1 to 90.6). This varied across countries: Wales (92.9%), England (95.1%) and Spain (95.1%). Antibiotic prescribing was associated with a higher symptom severity (OR: 1.22, p<0.001), positive leukocytes (OR: 10.61, p<0.001) and positive blood dipstick test (OR: 2.28, p=0.044).Median time to full recovery was 8 days for those who had a MC-UTI and 10 days for those who did not. Cox regression analysis found that the time to fully recovery was slower for higher symptom severity at initial consultation (HR 0.95, p<0.01), slower for those who had been treated for a urine infection 1 or more times in the past year (HR: 0.64, p=0.01) and faster for those who were prescribed antibiotics (HR: 1.85, p<0.01). There was an association between prescribed antibiotics and time to full recovery, there was no evidence of any differential effect by having a MC-UTI.
There is significant variation between countries in the prevalence of MC-UTI in women presenting with suspected UTI. There is a high rate of prescribing for these women and this also varies greatly across countries. Predictors of microbiological confirmation and prescribing are predominantly based on features of the urine. Recovery is slower for the sick patients who have a history of UTI, but faster for those receiving antibiotics, regardless of the microbiological confirmation of their UTI.