TY - JOUR
T1 - Trends in urine sampling rates of general practice patients with suspected lower urinary tract infections in England, 2015-2022
T2 - a population-based study
AU - Ciaccio, Laura
AU - Fountain, Holly
AU - Beech, Elizabeth
AU - Brown, Colin S.
AU - Demirjian, Alicia
AU - Gerver, Sarah
AU - Muller-Pebody, Berit
AU - Bou-Antoun, Sabine
N1 - Publisher Copyright:
© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.
PY - 2024/6
Y1 - 2024/6
N2 - Objectives Inappropriate prescribing of antibiotics is a key driver of antimicrobial resistance. This study aimed to describe urine sampling rates and antibiotic prescribing for patients with lower urinary tract infections (UTIs) in English general practice. Design A retrospective population-based study using administrative data. Setting IQVIA Medical Research Database (IMRD) data from general practices in England, 2015-2022. Participants Patients who have consulted with an uncomplicated UTI in England general practices captured in the IMRD. Outcome measures Trends in UTI episodes (episodes were defined as UTI diagnosis codes occurring within 14 days of each other), testing and antibiotic prescribing on the same day as initial UTI consultation were assessed from January 2015 to December 2022. Associations, using univariate and multivariate logistic regressions, were examined between consultation and demographic factors on the odds of a urine test. Results There were 743 350 UTI episodes; 50.8% had a urine test. Testing rates fluctuated with an upward trend and large decline in 2020. Same-day UTI antibiotic prescribing occurred in 78.2% of episodes. In multivariate modelling, factors found to decrease odds of a urine test included age ≥85 years (0.83, 95% CI 0.82 to 0.84), consultation type (remote vs face to face, 0.45, 95% CI 0.45 to 0.46), episodes in London compared with the South (0.74, 95% CI 0.72 to 0.75) and increasing practice size (0.77, 95% CI 0.76 to 0.78). Odds of urine tests increased in males (OR 1.11, 95% CI 1.10 to 1.13), for those episodes without a same-day UTI antibiotic (1.10, 95% CI 1.04 to 1.16) for episodes for those with higher deprivation status (Indices of Multiple Deprivation 8 vs 1, 1.51, 95% CI 1.48 to 1.54). Compared with 2015, 2016-2019 saw increased odds of testing while 2020 and 2021 saw decreases, with 2022 showing increased odds. Conclusion Urine testing for UTI in general practice in England showed an upward trend, with same-day antibiotic prescribing remaining consistent, suggesting greater alignment to national guidelines. The COVID-19 pandemic impacted testing rates, though as of 2022, they began to recover.
AB - Objectives Inappropriate prescribing of antibiotics is a key driver of antimicrobial resistance. This study aimed to describe urine sampling rates and antibiotic prescribing for patients with lower urinary tract infections (UTIs) in English general practice. Design A retrospective population-based study using administrative data. Setting IQVIA Medical Research Database (IMRD) data from general practices in England, 2015-2022. Participants Patients who have consulted with an uncomplicated UTI in England general practices captured in the IMRD. Outcome measures Trends in UTI episodes (episodes were defined as UTI diagnosis codes occurring within 14 days of each other), testing and antibiotic prescribing on the same day as initial UTI consultation were assessed from January 2015 to December 2022. Associations, using univariate and multivariate logistic regressions, were examined between consultation and demographic factors on the odds of a urine test. Results There were 743 350 UTI episodes; 50.8% had a urine test. Testing rates fluctuated with an upward trend and large decline in 2020. Same-day UTI antibiotic prescribing occurred in 78.2% of episodes. In multivariate modelling, factors found to decrease odds of a urine test included age ≥85 years (0.83, 95% CI 0.82 to 0.84), consultation type (remote vs face to face, 0.45, 95% CI 0.45 to 0.46), episodes in London compared with the South (0.74, 95% CI 0.72 to 0.75) and increasing practice size (0.77, 95% CI 0.76 to 0.78). Odds of urine tests increased in males (OR 1.11, 95% CI 1.10 to 1.13), for those episodes without a same-day UTI antibiotic (1.10, 95% CI 1.04 to 1.16) for episodes for those with higher deprivation status (Indices of Multiple Deprivation 8 vs 1, 1.51, 95% CI 1.48 to 1.54). Compared with 2015, 2016-2019 saw increased odds of testing while 2020 and 2021 saw decreases, with 2022 showing increased odds. Conclusion Urine testing for UTI in general practice in England showed an upward trend, with same-day antibiotic prescribing remaining consistent, suggesting greater alignment to national guidelines. The COVID-19 pandemic impacted testing rates, though as of 2022, they began to recover.
KW - EPIDEMIOLOGY
KW - Primary Care
KW - Public health
KW - Urinary tract infections
UR - http://www.scopus.com/inward/record.url?scp=85200828382&partnerID=8YFLogxK
UR - https://www.mendeley.com/catalogue/b72ea004-bb14-3941-a483-c36e63e4bb68/
U2 - 10.1136/bmjopen-2024-084485
DO - 10.1136/bmjopen-2024-084485
M3 - Article
C2 - 39107033
AN - SCOPUS:85200828382
SN - 2044-6055
VL - 14
SP - e084485
JO - BMJ Open
JF - BMJ Open
IS - 8
M1 - e084485
ER -