A qualitative analysis of diagnostic testing, antibiotic selection, and quality improvement interventions for uncomplicated urinary tract infections

Abstract

Background Uncomplicated urinary tract infections (UTIs) can often be diagnosed based solely on symptoms and should be treated with a short course of narrow spectrum antibiotics. However, clinicians often order urine analyses and prescribe long courses of broad spectrum antibiotics. Objective The objectives of our study are: 1) Understand how primary care providers and residents clinically approach UTIs and 2) to understand specific opportunities, based on provider type, to target future antibiotic stewardship interventions. Design and participants We conducted semi-structured qualitative interviews of community primary care providers (n = 15) and internal medicine residents (n = 15) in St. Louis, Missouri from 2018-2019. A 5point Likert scale was used to evaluate participant preferences for possible interventions. Interviews were transcribed, de-identified, and coded by two independent researchers using a combination inductive and deductive approach. Key results Several common themes emerged. Both providers and residents ordered urine tests to "confirm" presence of urinary tract infections. Antibiotic prescription decisions were often based on historical practice and anecdotal experience rather than local susceptibility data or clinical practice guidelines. Community providers were more comfortable treating patients over the phone than residents and tended to prescribe longer courses of antibiotics. Both community providers and residents voiced frustrations with guidelines being difficult to

Diagnostic value of different urine tests for urinary tract infection: a systematic review and meta-analysis

“…In the test data, the positive rate (43.7%) was higher than the negative rate (40.6%), and the Spe and Sen of the observation group were significantly higher than those of the control group, with a statistically significant difference (P<0.05) (33). Pinkerton et al (34) also found that combining the 2 test methods led to a significantly better Spe, Sen, positive predictive value, and negative predictive value than those of the urine dipstick test method alone, thus effectively improving the accuracy and authenticity of diagnosis (35). Because quantitative urine culture takes a long time, a urine dipstick test can be performed first and then confirmed by quantitative urine culture.…”

Educational interventions to prevent urinary infections in institutionalized elderly people. Quasi-experimental Study

“…In an international study about myths in the diagnosis and treatment of UTI, it was detected that many urine cultures are requested without proper indication, or the patient receives unnecessary antibiotic therapy due to the high value given to lab tests to the detriment of the clinical practice. 17 Recognizing what the older adult reports or feels in the process of determining an urinary infection is important to help the doctor provide a conclusive diagnosis and monitor the evolution of the cases. 16 , 18 .…”

Patients’ Experiences, Expectations, Motivations, and Perspectives around Urinary Tract Infection Care in General Practice: A Qualitative Interview Study

“…Patients' preference for antibiotics arises from previous positive experiences [14], a reason mentioned frequently in our study. Therefore, we hypothesise that due to the previous treatments, patients link symptom reduction to antibiotics and consider them necessary to cure UTIs, a notion held by patients from previous studies [14][15][16]. This association needs to be broken in order for antibiotic prescribing for UTIs to change [17].…”