Primary Care Medical Group, Community Clinical Sciences Division (CCS), School of Medicine, University of Southampton, Aldermoor Health Centre, Southampton SO16 6ST.
BMJ. 2010 Feb 5;340:b5633. doi: 10.1136/bmj.b5633.
To assess the natural course and the important predictors of severe symptoms in urinary tract infection and the effect of antibiotics and antibiotic resistance.
Observational study.
Primary care.
839 non-pregnant adult women aged 18-70 presenting with suspected urinary tract infection.
Duration and severity of symptoms.
684 women provided some information on symptoms; 511 had both laboratory results and complete symptom diaries. For women with infections sensitive to antibiotics, severe symptoms, rated as a moderately bad problem or worse, lasted 3.32 days on average. After adjustment for other predictors, moderately bad symptoms lasted 56% longer (incidence rate ratio 1.56, 95% confidence interval 1.22 to 1.99, P<0.001) in women with resistant infections; 62% longer (1.62, 1.13 to 2.31, P=0.008) when no antibiotics prescribed; and 33% longer (1.33, 1.14 to 1.56, P<0.001) in women with urethral syndrome. The duration of symptoms was shorter if the doctor was perceived to be positive about diagnosis and prognosis (continuous 7 point scale: 0.91, 0.84 to 0.99; P=0.021) and longer when the woman had frequent somatic symptoms (1.03, 1.01 to 1.05, P=0.002; for each symptom), a history of cystitis, urinary frequency, and more severe symptoms at baseline.
Antibiotic resistance and not prescribing antibiotics are associated with a greater than 50% increase in the duration of more severe symptoms in women with uncomplicated urinary tract infection. Women with a history of cystitis, frequent somatic symptoms (high somatisation), and severe symptoms at baseline can be given realistic advice that they are likely to have severe symptoms lasting longer than three days.
评估尿路感染严重症状的自然病程和重要预测因素，以及抗生素和抗生素耐药性的影响。
观察性研究。
初级保健。
839 名年龄在 18-70 岁之间的非妊娠成年女性，表现出疑似尿路感染。
症状的持续时间和严重程度。
684 名女性提供了一些症状信息；511 名女性既有实验室结果又有完整的症状日记。对于对抗生素敏感的感染女性，严重症状（评为中度严重或更严重的问题）平均持续 3.32 天。在调整其他预测因素后，耐药感染女性中度严重症状持续时间延长 56%（发病率比 1.56，95%置信区间 1.22 至 1.99，P<0.001）；未开处方抗生素的女性延长 62%（1.62，1.13 至 2.31，P=0.008）；尿道综合征女性延长 33%（1.33，1.14 至 1.56，P<0.001）。如果医生对诊断和预后持积极态度（连续 7 分制：0.91，0.84 至 0.99；P=0.021），症状持续时间会缩短，如果女性经常出现躯体症状（1.03，1.01 至 1.05，P=0.002；每增加一个症状）、膀胱炎病史、尿频和基线时更严重的症状，症状持续时间会延长。
在无并发症尿路感染女性中，抗生素耐药性和未开抗生素与更严重症状持续时间延长超过 50%相关。有膀胱炎病史、经常出现躯体症状（高度躯体化）和基线时症状严重的女性，可以得到现实的建议，即她们可能会出现严重症状，持续时间超过三天。
