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. 2022 Sep 7;23(1):224.
doi: 10.1186/s12875-022-01840-6.

Adherence to and usefulness of the national treatment guideline for urinary tract infections (UTI) in a risk area

A A van Driel  1 , M Mulder  2   3 , E E Stobberingh  3   4 , A Verbon  5
Affiliations

Adherence to and usefulness of the national treatment guideline for urinary tract infections (UTI) in a risk area

A A van Driel et al. BMC Prim Care. .

Abstract

Background: To optimize antibiotic treatment and decrease antibiotic resistance, national treatment guidelines are available for urinary tract infections (UTIs) in general practice. The usefulness of these guidelines in risk areas for antimicrobial resistance such as cross border regions or areas with dense agriculture, is unknown.

Methods: Midstream urine samples from women with symptoms of acute UTI visiting general practitioners (GPs) in the Westland area, a dense agriculture area, were microbiologically analysed, and patient characteristics, symptoms, previous and present antibiotic treatment were collected. The National Nivel data were used as reference for antibiotic resistance.

Results: Of 310 women with symptoms of uncomplicated UTI, 247 (80%) had a culture proven E. coli UTI. Empirical antibiotic therapy was prescribed to 148 patients (48%) in total; in 7% of women with a negative and 52% with a positive urine culture. Having more than one symptom was associated with the prescription of antibiotics; travel history or previous antibiotic use for UTI were not. The isolated uropathogens were susceptible to the empiric antibiotic therapy in 98% of patients. Resistance to co-amoxiclav was higher (22%) than reported in the national data of 2004 (12%), 2009 (13%) and 2014 (9%), as was the prevalence of extended spectrum β-lactamase (ESBL): 3.4% in our study versus 0.1%, 1% and 2.2% in the national data respectively.

Conclusion: The presence of environmental and socio-demographic risk factors for antibiotic resistance did not influence the empiric choice nor susceptibility for antibiotics advised by the national guidelines in women with uncomplicated UTI.

Keywords: Agriculture; Antibiotic resistance; Community-acquired; Empirical prescription; Treatment guidelines; Uncomplicated urine tract infections.

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Conflict of interest statement

The authors declare that they have no competing interest.

Figures

Fig. 1
Fig. 1
Inclusion of patients with symptoms of an UTI. Figure 1 shows the inclusion of patients presenting with UTI symptoms in 8 GP’s in the Westland and whether empirical antibiotics (AB) were prescribed. Two patients were excluded due to an incomplete questionnaire (n = 2). The diagnosis of UTI was confirmed by laboratory culture analyses after clinical presentation and diagnoses of the GP
Fig. 2
Fig. 2
Percentages of antibiotic resistance of E. coli of the Westland (2018), NIVEL 2004, 2009, and 2014. Figure 2 shows the AMR percentage of the Westland in comparison to the NIVEL study of 2004, 2009 and 2014 [–30]. Also the percentage of ESBL is shown
See this image and copyright information in PMC

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