33
views
0
recommends
+1 Recommend
1 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Point of care testing for urinary tract infection in primary care (POETIC): protocol for a randomised controlled trial of the clinical and cost effectiveness of FLEXICULT™ informed management of uncomplicated UTI in primary care

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Background

          Urinary tract infections (UTI) are the most frequent bacterial infection affecting women and account for about 15% of antibiotics prescribed in primary care. However, some women with a UTI are not prescribed antibiotics or are prescribed the wrong antibiotics, while many women who do not have a microbiologically confirmed UTI are prescribed antibiotics. Inappropriate antibiotic prescribing unnecessarily increases the risk of side effects and the development of antibiotic resistance, and wastes resources.

          POETIC is a randomised controlled trial of a Point Of Care Test (POCT) (Flexicult™) guided UTI management strategy for use in primary care, which may help General Practitioners more effectively decide both whether or not to prescribe antibiotics, and if so, to select the most appropriate antibiotic.

          Methods/design

          614 adult female patients will be recruited from four primary care research networks (Wales, England, Spain, the Netherlands) and individually randomised to either POCT guided care or the guideline-informed ‘standard care’ arm. Urine and stool samples (where possible) will be obtained at presentation (day 1) and two weeks later for microbiological analysis. All participants will be followed up on the course of their illness and their quality of life, using a 2 week self-completed symptom diary. At 3 months, a primary care notes review will be conducted for evidence of further evidence of treatment failures, recurrence, complications, hospitalisations and health service costs.

          The primary objective is to compare appropriate antibiotic use on day 3 between the POCT and standard care arms using multi-level logistic regression to produce an odds ratio and associated 95% confidence interval. Costs of the two management approaches will be assessed in terms of the primary outcome.

          Discussion

          Although the Flexicult™ POCT is used in some countries in routine primary care, it’s clinical and cost effectiveness has never been evaluated in a randomised clinical trial. If shown to be effective, the use of this POCT could benefit individual sufferers and provide evidence for health care authorities to develop evidence based policies to combat the spread and impact of the unprecedented rise of infections caused by antibiotic resistant bacteria in Europe.

          Trial registration number

          ISRCTN65200697 (Registered 10 September 2013).

          Related collections

          Most cited references 9

          • Record: found
          • Abstract: found
          • Article: not found

          Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients: systematic review and meta-analysis.

          To systematically review the literature and, where appropriate, meta-analyse studies investigating subsequent antibiotic resistance in individuals prescribed antibiotics in primary care. Systematic review with meta-analysis. Observational and experimental studies identified through Medline, Embase, and Cochrane searches. Review methods Electronic searches using MeSH terms and text words identified 4373 papers. Two independent reviewers assessed quality of eligible studies and extracted data. Meta-analyses were conducted for studies presenting similar outcomes. The review included 24 studies; 22 involved patients with symptomatic infection and two involved healthy volunteers; 19 were observational studies (of which two were prospective) and five were randomised trials. In five studies of urinary tract bacteria (14 348 participants), the pooled odds ratio (OR) for resistance was 2.5 (95% confidence interval 2.1 to 2.9) within 2 months of antibiotic treatment and 1.33 (1.2 to 1.5) within 12 months. In seven studies of respiratory tract bacteria (2605 participants), pooled ORs were 2.4 (1.4 to 3.9) and 2.4 (1.3 to 4.5) for the same periods, respectively. Studies reporting the quantity of antibiotic prescribed found that longer duration and multiple courses were associated with higher rates of resistance. Studies comparing the potential for different antibiotics to induce resistance showed no consistent effects. Only one prospective study reported changes in resistance over a long period; pooled ORs fell from 12.2 (6.8 to 22.1) at 1 week to 6.1 (2.8 to 13.4) at 1 month, 3.6 (2.2 to 6.0) at 2 months, and 2.2 (1.3 to 3.6) at 6 months. Individuals prescribed an antibiotic in primary care for a respiratory or urinary infection develop bacterial resistance to that antibiotic. The effect is greatest in the month immediately after treatment but may persist for up to 12 months. This effect not only increases the population carriage of organisms resistant to first line antibiotics, but also creates the conditions for increased use of second line antibiotics in the community.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Uncomplicated urinary tract infection in adults including uncomplicated pyelonephritis.

            Acute uncomplicated urinary tract infection and acute pyelonephritis are very common infections affecting many women throughout their lives. The determinants of infection have been well described and current strategies to prevent recurrent infections are highly effective. While antimicrobial management is straightforward for most episodes, the evolution of antimicrobial susceptibility of E. coli in community-acquired infection requires continuing re-evaluation of appropriate empiric therapy.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Prior antibiotics and risk of antibiotic-resistant community-acquired urinary tract infection: a case-control study.

              To assess the effect of previous antibiotic use on the risk of a resistant Escherichia coli urinary tract infection (UTI), we undertook a case-control study with prospective measurement of outcomes in 10 general practices in the UK. Urinary samples from all patients with symptoms suggestive of UTIs were sought, and those with a laboratory-proven E. coli infection were interviewed and their medical records examined. Case patients were those with ampicillin- or trimethoprim-resistant infections and control patients had infections that were susceptible to antibiotics, including ampicillin and trimethoprim. Risk of ampicillin-resistant E. coli infection in 903 patients was associated with amoxicillin prescriptions of >or=7 days duration in the previous 1 month [odds ratio (OR)=3.91, 95% CI 1.64-9.34] and previous 2-3 months (2.29, 1.12-4.70) before illness onset. For prescriptions or=7 days in the previous month and 13.91 (3.32-58.31) for the previous 2-3 months. For trimethoprim prescriptions of <7 days, the OR was 4.03 (1.69-9.59) for the previous month but prescribing in earlier periods was not significantly associated with resistance. Within the community setting, exposure to antibiotics is a strong risk factor for a resistant E. coli UTI. High-dose, shorter-duration antibiotic regimens may reduce the pressure on the emergence of antibiotic resistance.
                Bookmark

                Author and article information

                Contributors
                BatesMJ@cf.ac.uk
                Thomas-JonesE@cardiff.ac.uk
                PicklesTE@cf.ac.uk
                KirbyN@cf.ac.uk
                GalM@cardiff.ac.uk
                BongardEJ@cf.ac.uk
                HoodK1@cardiff.ac.uk
                FrancisNA@cf.ac.uk
                P.Little@soton.ac.uk
                mvm198@soton.ac.uk
                K.Martinson@soton.ac.uk
                Carles.llor@urv.cat
                C.Brugman@umcutrecht.nl
                th.j.m.verheij@umcutrecht.nl
                dcohen@glam.ac.uk
                Mandy.Wootton@wales.nhs.uk
                Robin.Howe@wales.nhs.uk
                ButlerCC@cardiff.ac.uk
                Journal
                BMC Fam Pract
                BMC Fam Pract
                BMC Family Practice
                BioMed Central (London )
                1471-2296
                25 November 2014
                25 November 2014
                2014
                : 15
                : 1
                Affiliations
                [ ]South East Wales Trials Unit (SEWTU), School of Medicine, Cardiff University, 7th Floor Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4XN UK
                [ ]Institute of Primary Care & Public Health, School of Medicine, Cardiff University, 5th Floor Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4XN UK
                [ ]Department of Primary Medical Care, University of Southampton, Aldermoor Close, Southampton, SO16 5ST UK
                [ ]Primary Care Centre Jaume I, University Rovira i Virgili, Felip Pedrell, 45-47, 43005 Tarragona, Spain
                [ ]Julius Center for Health Sciences and Primary Care, UMC Utrecht, PO Box 85500, Utrecht, GA 3508 Netherlands
                [ ]Health Economics and Policy Research Unit, University of Glamorgan, Faculty of Health, Sports & Science, Pontypridd, CF37 1DL UK
                [ ]Specialist Antimicrobial Chemotherapy Unit, Public Health Wales Microbiology Cardiff, University Hospital Wales, Heath Park, Cardiff, CF14 4XW UK
                Article
                187
                10.1186/s12875-014-0187-4
                4251943
                25425162
                © Bates et al.; licensee BioMed Central Ltd. 2014

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                Categories
                Study Protocol
                Custom metadata
                © The Author(s) 2014

                Comments

                Comment on this article