Diagnostic Process in Patients With a Suspected Urinary Trcat Infection in Danish Primary Care: Impact on Appropriate Use of Antibiotics and Patient's Recovery.

Background

The latest report from the Staten Serum Institute (SSI)1 showed that primary health care in Denmark represents 90% of all prescribed defined daily dose(DDD) of antibiotics, and that a growing consumption of antibiotics is running alongside increasing resistance to E. coli, specifically ESBL-producing E. coli (Extended Spectrum Beta Lactamase Producing E. coli) .

The main cause of E. coli infection at primary care level is a Urinary Tract Infection (UTI) which is one of the most frequent reasons for consultation in general practice in Denmark. Interestingly, there is no consensus yet about the most effective diagnostic approach to identify those patients that will benefit from antibiotic therapy.

Currently in Denmark, a wide variety of diagnostic approaches can be identified in primary care settings (i.e. only history taking, dipsticks, microscopy, culture and susceptibility testing in practice). Nonetheless, there is not conclusive evidence yet about the diagnostic validity of all these approaches and the association with appropriate prescription of antibiotics(i.e. correct decision to prescribe and correct choice of antibiotics reflecting the bacterial cause and resistance) and impact on patients' clinical and microbiological cure.

For example, some studies that only include uncomplicated UTIs have shown that symptoms alone have a very low predictive value leading to overuse of antibiotics2,3. However, Richards et al after comparing the response to antibiotics of women with symptoms of UTI and a negative dipstick test result, concluded that empirical antibiotic use guided only by symptoms was a reasonable option4.