Ng Li Yan, Goh Lay Hoon, van der Lubbe Stephanie C C, Koh Sky Wei Chee
National University Polyclinics, National University Health System, Singapore, 609606, Singapore.
Division of Family Medicine, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119228, Singapore.
Sci Rep. 2025 Apr 29;15(1):15055. doi: 10.1038/s41598-025-99067-9.
Urinary tract infections (UTIs) are commonly treated in primary care. Inappropriate antibiotic prescription promotes treatment failure and antimicrobial resistance. To date, there are no studies to evaluate antibiotic appropriateness in UTIs in Singapore. We assessed antibiotic appropriateness in uncomplicated UTIs (uUTIs) and identified factors influencing appropriate prescribing. An inappropriate prescription was defined as one involving an inaccurate uUTI diagnosis, not in line with the 2023 Ministry of Health Singapore Clinical Guideline on UTI, or both. We conducted a retrospective observational study of uUTIs from January to June 2023, using Point Prevalence Survey methodology, at 7 primary care clinics in Singapore. Factors influencing appropriate prescribing were identified with bivariate analysis and multivariable logistic regression. Among 369 uUTIs, 53.4% had inappropriate antibiotic prescriptions. Amoxicillin/clavulanate was the most prescribed antibiotic (47.2%). Inappropriate antibiotic prescriptions were more likely if patients had an antibiotic drug allergy (OR 2.49, 95% CI [1.29-4.81], p = 0.006) or multiple complaints (OR 1.32, 95% CI [1.09-1.61], p = 0.005). The clinic visited significantly influenced antibiotic appropriateness (p = 0.004). This study can galvanise local authorities to institute targeted interventions, including clinical decision support tools, shared decision making and continuing medical education to improve antibiotic stewardship in primary care.
尿路感染（UTIs）通常在初级医疗保健中进行治疗。不恰当的抗生素处方会导致治疗失败和抗菌素耐药性。迄今为止，尚无研究评估新加坡尿路感染中抗生素使用的恰当性。我们评估了单纯性尿路感染（uUTIs）中抗生素使用的恰当性，并确定了影响恰当处方的因素。不恰当的处方被定义为涉及uUTI诊断不准确、不符合2023年新加坡卫生部尿路感染临床指南，或两者皆有的情况。我们采用现患率调查方法，对2023年1月至6月期间新加坡7家初级医疗保健诊所的uUTIs进行了一项回顾性观察研究。通过双变量分析和多变量逻辑回归确定影响恰当处方的因素。在369例uUTIs中，53.4%的患者有不恰当的抗生素处方。阿莫西林/克拉维酸是最常开具的抗生素（47.2%）。如果患者有抗生素药物过敏（比值比2.49，95%置信区间[1.29 - 4.81]，p = 0.006）或有多种症状（比值比1.32，95%置信区间[1.09 - 1.61]，p = 0.005），则更有可能出现不恰当的抗生素处方。就诊的诊所对抗生素使用的恰当性有显著影响（p = 0.004）。本研究可促使地方当局采取有针对性的干预措施，包括临床决策支持工具、共同决策和继续医学教育，以改善初级医疗保健中的抗生素管理。
