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Point of care susceptibility testing in primary care - does it lead to a more appropriate prescription of antibiotics in patients with uncomplicated urinary tract infections? Protocol for a randomized controlled trial.

Holm A, Cordoba G, Sørensen TM, Jessen LR, Siersma V, Bjerrum L - BMC Fam Pract (2015)

Bottom Line: However, the clinical effect of the culture and susceptibility test has not yet been investigated.The results of this study may provide important evidence to recommend POCT culture and susceptibility testing in all patients with suspected uncomplicated UTI.This could become an additional strategy to fight antibiotic resistance.

View Article: PubMed Central - PubMed

Affiliation: Department of Public Health, The Research Unit for General Practice and Section of General Practice, University of Copenhagen, Øster Farimagsgade 5 opg. Q, PO box 2099, 1014, Copenhagen K, Denmark. anneholm@sund.ku.dk.

ABSTRACT

Background: Urinary tract infection (UTI) is a common infection in primary care and is the second leading reason for prescription of antibiotics in Denmark. The diagnosis is often based on symptoms and urine dip-stick, which has limited validity, causing the risk of unnecessary antibiotic prescription. Additionally, with increasing antibiotic resistance, the risk of choosing an antibiotic to which an infecting pathogen is resistant is rising. Combined point-of-care-tests (POCT) for urine culture and susceptibility testing have been developed and validated for primary care, and performing such a test in all patients with suspected UTI in primary care seems rational in order to reduce the use of inappropriate antibiotics. However, the clinical effect of the culture and susceptibility test has not yet been investigated. This study aims to investigate whether POCT urine culture and susceptibility testing decreases the inappropriate use of antibiotics and leads to faster patient recovery.

Methods/design: Randomized controlled open label trial of two diagnostic approaches. 750 patients with symptoms of uncomplicated UTI, consecutively contacting their general practitioner (GP), randomized to either POCT urine culture and susceptibility testing and targeted treatment or POCT urine culture without susceptibility testing and empirical treatment. Treatment is started when the POCT is read. The two groups are compared with regard to appropriate choice of antibiotics, clinical remission, and microbiological cure rates.

Discussion: The results of this study may provide important evidence to recommend POCT culture and susceptibility testing in all patients with suspected uncomplicated UTI. This could become an additional strategy to fight antibiotic resistance.

Trial registration: ClinicalTrials.gov NCT02323087 .

No MeSH data available.


Related in: MedlinePlus

Flow-chart for data collection. POCT: Point of care test. This refers both to POCT culture and POCT culture and susceptibility testing. GP: General practitioner
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Related In: Results  -  Collection

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Fig1: Flow-chart for data collection. POCT: Point of care test. This refers both to POCT culture and POCT culture and susceptibility testing. GP: General practitioner

Mentions: Figure 1 illustrates the data collection process and Fig. 2 explains the study design and the difference between the intervention and control arm.Fig. 1


Point of care susceptibility testing in primary care - does it lead to a more appropriate prescription of antibiotics in patients with uncomplicated urinary tract infections? Protocol for a randomized controlled trial.

Holm A, Cordoba G, Sørensen TM, Jessen LR, Siersma V, Bjerrum L - BMC Fam Pract (2015)

Flow-chart for data collection. POCT: Point of care test. This refers both to POCT culture and POCT culture and susceptibility testing. GP: General practitioner
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4546106&req=5

Fig1: Flow-chart for data collection. POCT: Point of care test. This refers both to POCT culture and POCT culture and susceptibility testing. GP: General practitioner
Mentions: Figure 1 illustrates the data collection process and Fig. 2 explains the study design and the difference between the intervention and control arm.Fig. 1

Bottom Line: However, the clinical effect of the culture and susceptibility test has not yet been investigated.The results of this study may provide important evidence to recommend POCT culture and susceptibility testing in all patients with suspected uncomplicated UTI.This could become an additional strategy to fight antibiotic resistance.

View Article: PubMed Central - PubMed

Affiliation: Department of Public Health, The Research Unit for General Practice and Section of General Practice, University of Copenhagen, Øster Farimagsgade 5 opg. Q, PO box 2099, 1014, Copenhagen K, Denmark. anneholm@sund.ku.dk.

ABSTRACT

Background: Urinary tract infection (UTI) is a common infection in primary care and is the second leading reason for prescription of antibiotics in Denmark. The diagnosis is often based on symptoms and urine dip-stick, which has limited validity, causing the risk of unnecessary antibiotic prescription. Additionally, with increasing antibiotic resistance, the risk of choosing an antibiotic to which an infecting pathogen is resistant is rising. Combined point-of-care-tests (POCT) for urine culture and susceptibility testing have been developed and validated for primary care, and performing such a test in all patients with suspected UTI in primary care seems rational in order to reduce the use of inappropriate antibiotics. However, the clinical effect of the culture and susceptibility test has not yet been investigated. This study aims to investigate whether POCT urine culture and susceptibility testing decreases the inappropriate use of antibiotics and leads to faster patient recovery.

Methods/design: Randomized controlled open label trial of two diagnostic approaches. 750 patients with symptoms of uncomplicated UTI, consecutively contacting their general practitioner (GP), randomized to either POCT urine culture and susceptibility testing and targeted treatment or POCT urine culture without susceptibility testing and empirical treatment. Treatment is started when the POCT is read. The two groups are compared with regard to appropriate choice of antibiotics, clinical remission, and microbiological cure rates.

Discussion: The results of this study may provide important evidence to recommend POCT culture and susceptibility testing in all patients with suspected uncomplicated UTI. This could become an additional strategy to fight antibiotic resistance.

Trial registration: ClinicalTrials.gov NCT02323087 .

No MeSH data available.


Related in: MedlinePlus