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Management of urinary tract infection by early-career general practitioners in Australia

Citation

Davey, A and Tapley, A and Mulquiney, K and van Driel, M and Fielding, A and Holliday, E and Ball, J and Spike, N and FitzGerald, K and Magin, P, Management of urinary tract infection by early-career general practitioners in Australia, Journal of Evaluation in Clinical Practice pp. 1-8. ISSN 1356-1294 (2019) [Refereed Article]


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DOI: doi:10.1111/jep.13340

Abstract

Rationale, aims, and objectives: Urinary tract infection (UTI) is a common presentation to general practitioners (GPs). There is increasing antimicrobial resistance in urinary pathogens in many healthcare systems. Adherence to principles of antimicrobial stewardship is important to combat this problem. Our aim was to describe the prevalence of presentations of clinically diagnosed new UTI to early-career GPs, to describe management choices made, and to identify associations of prescribing antibiotics at the index consultation for UTI.

Method: This is a cross-sectional analysis of the Registrar Clinical Encounters in Training cohort study. Early-career GPs from five Australian states (urban to very remote practices) collected data on 60 consecutive patient encounters during each of three 6-month training terms. Proportions of problems being new UTIs, antibiotics prescribed, urine microscopy and culture ordered were calculated. Univariate and multivariable logistic regressions established associations of patient, registrar, and practice factors with prescribing antibiotics for a new UTI.

Results: One thousand three hundred thirty-three early-career GPs diagnosed 2850 new UTIs from 189 736 consultations (1.5%; 95% CI, 1.4-1.6). Antibiotics were prescribed at 86% (95% CI, 84.7-87.2) of these index consultations. Antibiotic choice followed Australian therapeutic guideline recommendations. Urine microscopy and culture were requested at the index consultation less than recommended by guidelines in men, 69.2% (95% CI, 62.6-75.1), and children, 80.8% (95% CI, 76.4-84.6). Adults were significantly more likely to be treated with antibiotics at the index consultation than children under 16.

Conclusions: A new UTI is a common presentation to Australian early-career GPs. There is general adherence to guidelines for antibiotic choice in UTIs. Further research is needed, however, to understand some decisions made when managing UTI in children and men. This may reflect diagnostic uncertainty with consequent attention to antibiotic stewardship by deferring antibiotic prescription.

Item Details

Item Type:Refereed Article
Keywords:antibacterial agents, cross-sectional studies, general practitioners, prevalence, urinary tract infections
Research Division:Medical and Health Sciences
Research Group:Clinical Sciences
Research Field:Nephrology and Urology
Objective Division:Health
Objective Group:Clinical Health (Organs, Diseases and Abnormal Conditions)
Objective Field:Urogenital System and Disorders
UTAS Author:FitzGerald, K (Dr Kristen FitzGerald)
ID Code:137024
Year Published:2019
Deposited By:Medicine
Deposited On:2020-01-29
Last Modified:2020-02-26
Downloads:0

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