巴伐利亚州门诊尿路感抗生素处方：常规数据分析。

Prescription of antibiotics for urinary tract infections in outpatient care in Bavaria: An analysis of routine data.

机构信息

Department of General Practice, University Hospital Würzburg, Würzburg, Bavaria, Germany.

Institute of General Practice, University Hospital Erlangen, Erlangen, Bavaria, Germany.

出版信息

PLoS One. 2024 Oct 25;19(10):e0312620. doi: 10.1371/journal.pone.0312620. eCollection 2024.

DOI:10.1371/journal.pone.0312620

PMID:39453905

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11508671/

Abstract

BACKGROUND

Patients with urinary tract infection (UTI) in German outpatient care are usually treated by general practitioners (GPs), as well as by other specialties. To prevent antibiotic resistances and side effects, German guidelines recommend fosfomycin, nitrofurantoin, pivmecillinam and nitroxoline as first-line treatments, and advice against broad-spectrum antibiotics such as fluoroquinolones and cephalosporins. However, data from the European Centre for Disease Prevention and Control indicates a significant proportion of second-line antibiotics in German outpatient care. Our aim was to analyze whether antibiotic prescription has changed over time in accordance with guidelines. In addition, we aimed to investigate whether specialties prescribe different antibiotics for UTIs and whether prescription varies according to patient age and sex. For patients receiving more than one antibiotic, we wanted to determine whether subsequent prescriptions show a change in substances and specialties involved.

METHODS

This retrospective study involved routine data (2013 to 2019) provided by the Bavarian Association of Statutory Health Insurance Physicians. Data on diagnoses and prescriptions were transmitted from outpatient care physicians on a quarterly basis. UTI patients ≥12 years were included.

RESULTS

We analyzed 1.7 million UTI prescription cases. In females, shares of fluoroquinolones decreased sharply over time, while shares of first-line substances fosfomycin and pivmecillinam increased. Gynecologists showed the highest shares of first-line substances compared to GPs and urologists. Fluoroquinolone shares decreased in all three specialty groups. In females, older patients showed lower shares of first-line substances than younger patients. If a second or third antibiotic was prescribed, fosfomycin shares decreased, while shares of nitrofurantoin, nitroxoline and cephalosporins increased.

CONCLUSIONS

Our findings show a trend towards a more guideline-adherent prescribing in the treatment of UTI, with a significant increase of shares of fosfomycin and pivmecillinam, especially in women, and a sharp decrease of shares of fluoroquinolones.

摘要

背景

德国门诊治疗的尿路感染（UTI）患者通常由全科医生（GP）和其他专科医生治疗。为了预防抗生素耐药性和副作用，德国指南建议将磷霉素、呋喃妥因、匹美西林和硝呋太尔作为一线治疗药物，并建议避免使用氟喹诺酮类和头孢菌素等广谱抗生素。然而，欧洲疾病预防控制中心的数据表明，德国门诊治疗中大量使用二线抗生素。我们的目的是分析抗生素的处方是否随着时间的推移而按照指南进行了改变。此外，我们还旨在调查不同专科医生是否会为 UTI 开具不同的抗生素，以及处方是否会因患者年龄和性别而异。对于接受多种抗生素治疗的患者，我们希望确定后续处方中涉及的药物和专科是否发生了变化。

方法

这是一项回顾性研究，涉及巴伐利亚州法定健康保险医师协会提供的常规数据（2013 年至 2019 年）。门诊医生每季度上传诊断和处方数据。纳入年龄≥12 岁的 UTI 患者。

结果

我们分析了 170 万例 UTI 处方病例。在女性中，氟喹诺酮类药物的比例随着时间的推移急剧下降，而一线药物磷霉素和匹美西林的比例则增加。与全科医生和泌尿科医生相比，妇科医生的一线药物比例最高。所有三个专科组的氟喹诺酮类药物比例均下降。在女性中，年龄较大的患者比年龄较小的患者使用一线药物的比例更低。如果开具了第二或第三种抗生素，磷霉素的比例会下降，而呋喃妥因、硝呋太尔和头孢菌素的比例会增加。