Urinary tract infections in general practice patients: diagnostic tests versus bacteriological culture

fitness news
,
 Font size Women’s Health

Urinary tract infections in general practice patients: diagnostic tests versus bacteriological culture
 

– Reported, January 26, 2013

 

An acute uncomplicated urinary tract infection (UTI) is one of the most common bacterial infections in women. It is estimated that as many as 60% of all women report having had a UTI at least once in their lifetime. The majority of UTIs are caused by Escherichia coli followed by Staphylococcus saprophyticus, mainly in younger women. Klebsiella, Proteus and Enterobacter species are isolated less frequently.

For the diagnosis of a UTI the general practitioner (GP) can rely, besides the symptoms of the patient, on the results of the nitrite and leucocyte-esterase (LE) dipstick tests performed on urine samples.Several studies in The Netherlands on the antibiotic susceptibility patterns of uropathogens showed an increased resistance to widely used agents like trimethoprim and amoxicillin.

However, most information concerning the isolated uropathogens and their antimicrobial susceptibility was derived from samples sent in by the GPs, after prior (once or twice) therapy failure had occurred.

Therefore, these samples are likely to reflect a sample bias. Consequently an underestimation of the antibiotic susceptibility percentages of uropathogens from patients with an acute uncomplicated UTI is to be expected.

Recent data on the antimicrobial susceptibility of uropathogens isolated from patients with an acute uncomplicated UTI visiting their GP, i.e. the ‘unselected’ uropathogens, are needed for the set-up of evidence-based guidelines such as
those of the NHG. Therefore a study on acute uncomplicated UTIs in nonpregnant female patients between 11 and 70 years of age attending 21 general practices from the Sentinel Station of The Netherlands Institute for Health Services Research (NIVEL) was performed. In these patients care as usual of the GP concerning diagnostic procedures (i.e. nitrite and LE tests) and the treatment prescribed (choice and duration of the antimicrobial agent) were compared with the bacteriological culture results and the antimicrobial susceptibility of all the unselected E. coli isolates, the most important uropathogen, was determined.

This study in non-pregnant female patients of 11–70 years of age among 21 general practices throughout The Netherlands was a nationwide study on acute uncomplicated UTIs dealing with the care as usual of the GP, i.e. nitrite and LE test and the antibiotic therapy prescribed, bacteriological culture and the antimicrobial susceptibility of unselected E. coli isolates.

However, when both nitrite and LE tests are negative, a UTI cannot be excluded and the samples should be further investigated by culture. Furthermore, the GP should take into account the age of the patient when prescribing antibiotic treatment as the aetiology of a UTI is influenced by it. Prudent use of fluoroquinolones is strongly recommended as resistance is already emerging in the oldest patients. In addition, for an optimal empirical therapy actual data on antimicrobial resistance percentages of unselected uropathogens are required and these data should be made available to the GPs for implementation in their daily practice. Finally, as trimethoprim susceptibility in E. coli isolated in this study decreased to 80% it might be advisable to limit its use as first agent in the treatment of an acute uncomplicated UTI in The Netherlands.

CREDITS:
http://jac.oxfordjournals.org/
Sita Nys, T. van Merode, A. I. M. Bartelds and E. E. Stobberingh       

 

For more Netherland News Click Here