Division of Population Health and Genomics, University of Dundee School of Medicine, Dundee, UK
Healthcare-Associated Infection (HCAI), Fungal, Antimicrobial Resistance (AMR), Antimicrobial Use (AMU) & Sepsis Division, UK Health Security Agency, London, UK.
BMJ Open. 2024 Aug 6;14(8):e084485. doi: 10.1136/bmjopen-2024-084485.
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.
A retrospective population-based study using administrative data.
IQVIA Medical Research Database (IMRD) data from general practices in England, 2015-2022.
Patients who have consulted with an uncomplicated UTI in England general practices captured in the IMRD.
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.
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.
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.
抗生素的不适当使用是导致抗菌药物耐药性的一个关键因素。本研究旨在描述英国普通实践中治疗下尿路感染（UTI）患者的尿样采集率和抗生素处方情况。
一项使用管理数据的回顾性基于人群的研究。
英国 IQVIA 医疗研究数据库（IMRD）中普通实践的数据，时间为 2015 年至 2022 年。
在 IMRD 中记录的患有英国普通实践中简单性 UTI 的患者。
从 2015 年 1 月至 2022 年 12 月，评估了 UTI 发作（发作定义为在 14 天内发生的 UTI 诊断代码）、同一天进行的尿液检测和初始 UTI 咨询时的抗生素处方情况的趋势。使用单变量和多变量逻辑回归检查了咨询和人口统计学因素与尿液检测之间的关联。
共发生 743350 例 UTI 发作；其中 50.8%进行了尿液检测。检测率波动上升，2020 年大幅下降。78.2%的发作在当天开出了 UTI 抗生素处方。在多变量建模中，发现降低尿液检测几率的因素包括年龄≥85 岁（0.83，95%置信区间 0.82 至 0.84）、咨询类型（远程咨询与面对面咨询，0.45，95%置信区间 0.45 至 0.46）、伦敦与南部相比的发作次数（0.74，95%置信区间 0.72 至 0.75）和不断增加的实践规模（0.77，95%置信区间 0.76 至 0.78）。男性（比值比 1.11，95%置信区间 1.10 至 1.13）、无当天开出 UTI 抗生素处方（比值比 1.10，95%置信区间 1.04 至 1.16）和具有更高贫困程度（多因素剥夺指数 8 分与 1 分，1.51，95%置信区间 1.48 至 1.54）的发作中，尿液检测的几率增加。与 2015 年相比，2016-2019 年检测几率增加，而 2020 年和 2021 年检测几率下降，2022 年检测几率增加。
英国普通实践中 UTI 的尿样检测呈上升趋势，当天开出抗生素处方的情况保持一致，这表明与国家指南的一致性有所提高。COVID-19 大流行影响了检测率，但截至 2022 年，检测率开始恢复。
