利用抗菌药物耐药性信息和处方指南管理尿路感染：西米德兰兹郡全科医生调查

Use of antimicrobial resistance information and prescribing guidance for management of urinary tract infections: survey of general practitioners in the West Midlands.

作者信息

Ironmonger Dean, Edeghere Obaghe, Gossain Savita, Hawkey Peter M

机构信息

Field Epidemiology Service, Public Health England, 5 St Philips Place, Birmingham, UK.

Public Health Laboratory, Public Health England, Heart of England NHS Foundation Trust, Birmingham, UK.

出版信息

BMC Infect Dis. 2016 May 24;16:226. doi: 10.1186/s12879-016-1559-2.

DOI:10.1186/s12879-016-1559-2

PMID:27221321

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4877747/

Abstract

BACKGROUND

There is a marked variation in both antibiotic prescribing practice and urine sampling rates for diagnostic microbiology across general practices in England. To help understand factors driving this variation, we undertook a survey in 2012/13 to determine sampling protocols and antibiotic formularies used by general practitioners (GPs) for managing urinary tract infections (UTIs) in the West Midlands region of England.

METHOD

Cross-sectional survey of all eligible general practices in the West Midlands region of England undertaken in November 2012. GPs were invited to complete an online survey questionnaire to gather information on policies used within the practice for urine sampling for microbiological examination, and the source of antibiotic formularies used to guide treatment of UTIs. The questionnaire also gathered information on how they would manage five hypothetical clinical scenarios encountered in the community.

RESULTS

The response rate was 11.3 % (409/3635 GPs), equivalent to a practice response rate of 26 % (248/950). Only 50 % of GPs reported having a practice policy for urine sampling. Although there was good agreement from GPs regarding collecting specimens in scenarios symbolising treatment failure (98 %), UTI in an adult male (98 %) and asymptomatic UTI in pregnancy (97 %), there was variation in GPs requesting a specimen for the scenarios involving a suspected uncomplicated urinary tract infection (UTI) and an asymptomatic catheterised elderly patient; with 40 and 38 % respectively indicating they would collect a specimen for microbiological examination.

CONCLUSION

Standardised evidence based clinical management policies and antibiotic formularies for GPs should be readily available. This will promote the rational use of diagnostic microbiology services, improve antimicrobial stewardship and aid the interpretation of ongoing antimicrobial resistance surveillance.

摘要

背景

在英格兰，全科医疗中抗生素处方实践和用于诊断微生物学的尿液采样率存在显著差异。为了帮助理解导致这种差异的因素，我们在2012/13年进行了一项调查，以确定英格兰西米德兰兹地区全科医生（GP）用于管理尿路感染（UTI）的采样方案和抗生素处方集。

方法

2012年11月对英格兰西米德兰兹地区所有符合条件的全科医疗进行横断面调查。邀请全科医生完成一份在线调查问卷，以收集有关该诊所内用于微生物学检查的尿液采样政策以及用于指导UTI治疗的抗生素处方集来源的信息。该问卷还收集了他们将如何处理社区中遇到的五种假设临床情况的信息。

结果

回复率为11.3%（409/3635名全科医生），相当于诊所回复率为26%（248/950）。只有50%的全科医生报告有尿液采样的诊所政策。尽管全科医生在象征治疗失败的情况下（98%）、成年男性UTI（98%）和妊娠无症状UTI（97%）收集标本方面意见高度一致，但在涉及疑似单纯性尿路感染（UTI）和无症状导尿老年患者的情况下，全科医生要求采集标本的情况存在差异；分别有40%和38%的人表示他们会采集标本进行微生物学检查。