Uncomplicated urinary tract infections in Swedish primary care; Etiology, resistance and treatment
Kornfält Isberg, Helena LU ; Melander, Eva LU ; Hedin, Katarina LU ; Mölstad, Sigvard LU and Beckman, Anders LU
(2019)
In BMC Infectious Diseases
19(1).
- Abstract
Background: Uncomplicated urinary tract infection (uUTI) is common and a majority of patients are prescribed antibiotics. There is little knowledge about antibiotic resistance in urine samples from patients with uUTI in primary health care (PHC). The aim was to describe antibiotic treatment, bacterial findings, the prevalence of resistant E.coli and factors associated with antibiotic resistance. The aim was also to compare the prevalence of resistant E.coli in clinical practice with the prevalence of resistant E.coli in routine microbiological laboratory data. Methods: This observational study in PHC setting started in November 2014 and ended in March 2016. Women aged 17 years and older with symptoms indicating uUTI from eight PHCs were... (More)
Background: Uncomplicated urinary tract infection (uUTI) is common and a majority of patients are prescribed antibiotics. There is little knowledge about antibiotic resistance in urine samples from patients with uUTI in primary health care (PHC). The aim was to describe antibiotic treatment, bacterial findings, the prevalence of resistant E.coli and factors associated with antibiotic resistance. The aim was also to compare the prevalence of resistant E.coli in clinical practice with the prevalence of resistant E.coli in routine microbiological laboratory data. Methods: This observational study in PHC setting started in November 2014 and ended in March 2016. Women aged 17 years and older with symptoms indicating uUTI from eight PHCs were included. Questionnaires were used to retrieve anamnestic data. All urine samples were sent to the local laboratory of microbiology for diagnostic analysis and susceptibility testing. Proportions of resistant E.coli were compared with corresponding data from the regional laboratory. Results: Urine cultures were analysed in 304 women with a median age of 46 (IQR 32-66) years. Bacterial growth was found in 243 (80%) of urine samples, and E.coli in 72% of the positive samples. A total of 80% of detected E.coli isolates were susceptible to all tested antimicrobials and resistance rates to ciprofloxacin were lower than reported from the local clinical laboratory. Antibiotic treatment within the last year was independently associated with antibiotic resistant E.coli in the urine sample adjusted OR 4.97 (95% CI 2.04-12.06). A total of 74% of the women were treated with antibiotics. The most prescribed was pivmecillinam followed by nitrofurantoin. Conclusions: Antibiotic resistance in E.coli was low. Antibiotic treatment within the last year was associated with antibiotic resistant E.coli. Data from the clinical microbiology laboratory indicates that laboratory data may overestimate antibiotic resistance and lead to an unnecessary change in empiric antibiotic treatment of uUTI in primary care. The empirically prescribed antibiotics, were inline with Swedish treatment recommendations for uUTI.
(Less)
- author
- Kornfält Isberg, Helena
LU
; Melander, Eva
LU
; Hedin, Katarina
LU
; Mölstad, Sigvard
LU
and Beckman, Anders
LU
- organization
- publishing date
- 2019-02-13
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Antibiotic, Antibiotic resistance, E.Coli, General practice, Primary health care, Urinary tract infection, Urine culture
- in
- BMC Infectious Diseases
- volume
- 19
- issue
- 1
- article number
- 155
- publisher
- BioMed Central (BMC)
- external identifiers
-
- scopus:85061475371
- pmid:30760219
- ISSN
- 1471-2334
- DOI
- 10.1186/s12879-019-3785-x
- language
- English
- LU publication?
- yes
- id
- ae9c27c1-1182-4574-b81b-1655e458a90e
- date added to LUP
- 2019-02-21 08:50:01
- date last changed
- 2024-06-12 08:03:59
@article{ae9c27c1-1182-4574-b81b-1655e458a90e,
abstract = {{<p>Background: Uncomplicated urinary tract infection (uUTI) is common and a majority of patients are prescribed antibiotics. There is little knowledge about antibiotic resistance in urine samples from patients with uUTI in primary health care (PHC). The aim was to describe antibiotic treatment, bacterial findings, the prevalence of resistant E.coli and factors associated with antibiotic resistance. The aim was also to compare the prevalence of resistant E.coli in clinical practice with the prevalence of resistant E.coli in routine microbiological laboratory data. Methods: This observational study in PHC setting started in November 2014 and ended in March 2016. Women aged 17 years and older with symptoms indicating uUTI from eight PHCs were included. Questionnaires were used to retrieve anamnestic data. All urine samples were sent to the local laboratory of microbiology for diagnostic analysis and susceptibility testing. Proportions of resistant E.coli were compared with corresponding data from the regional laboratory. Results: Urine cultures were analysed in 304 women with a median age of 46 (IQR 32-66) years. Bacterial growth was found in 243 (80%) of urine samples, and E.coli in 72% of the positive samples. A total of 80% of detected E.coli isolates were susceptible to all tested antimicrobials and resistance rates to ciprofloxacin were lower than reported from the local clinical laboratory. Antibiotic treatment within the last year was independently associated with antibiotic resistant E.coli in the urine sample adjusted OR 4.97 (95% CI 2.04-12.06). A total of 74% of the women were treated with antibiotics. The most prescribed was pivmecillinam followed by nitrofurantoin. Conclusions: Antibiotic resistance in E.coli was low. Antibiotic treatment within the last year was associated with antibiotic resistant E.coli. Data from the clinical microbiology laboratory indicates that laboratory data may overestimate antibiotic resistance and lead to an unnecessary change in empiric antibiotic treatment of uUTI in primary care. The empirically prescribed antibiotics, were inline with Swedish treatment recommendations for uUTI.</p>}},
author = {{Kornfält Isberg, Helena and Melander, Eva and Hedin, Katarina and Mölstad, Sigvard and Beckman, Anders}},
issn = {{1471-2334}},
keywords = {{Antibiotic; Antibiotic resistance; E.Coli; General practice; Primary health care; Urinary tract infection; Urine culture}},
language = {{eng}},
month = {{02}},
number = {{1}},
publisher = {{BioMed Central (BMC)}},
series = {{BMC Infectious Diseases}},
title = {{Uncomplicated urinary tract infections in Swedish primary care; Etiology, resistance and treatment}},
url = {{http://dx.doi.org/10.1186/s12879-019-3785-x}},
doi = {{10.1186/s12879-019-3785-x}},
volume = {{19}},
year = {{2019}},
}