Urinary tract infection. Current management strategies

[Do urocultures change our therapy approach?]

OBJECTIVE

To describe to what extent the results of urocultures modify approaches to therapy and the factors linked to this change.

DESIGN

Cross-sectional, descriptive study by means of review of records.

SETTING

Primary care.

PARTICIPANTS

222 adult urocultures requested at 8 health centres between March and May 1999.

INTERVENTIONS

We extracted from the records age, sex, symptoms, risk factors, and approach to therapy before and after the uroculture. We discarded 358 urocultures because of not finding the clinical record or because the episode or data on the change in approach to therapy was lacking in the record.

RESULTS

The urocultures belonged to patients with a mean age of 54.2, 73.1% of whom were women. 34.7% presented no risk factor for UTI. 44% had no symptoms of UTI. 21.2% of urocultures were positive, with E. coli the most frequently isolated bacteria (69.4%). Empirical antibiotic treatment was called for in 44.6% (70.1% quinolones, 9.3% fosfomycin). After receipt of the result, there was a change of approach in 25 cases (11.4%, SE 2.1%), of whom 15 did not receive empirical treatment (6 with symptoms and 9 without). The antibiotic was changed in 9 of the 99 cases treated empirically (always because of resistance). Among those with change of approach, there was a higher percentage of risk factors (84% against 62%, p < 0.05, chi 2 = 4.47). There were no differences for age, sex, symptoms or bacteria between the two groups.

CONCLUSIONS

There is a quite considerable percentage of urocultures that lead to a change in approach to therapy, although most of the patients had linked risk factors and/or did not receive empirical antibiotic treatment.