Artikel
Dipsticks and point-of-care Microscopy to reduce antibiotic use in women with an uncomplicated Urinary Tract Infection (MicUTI) – a pragmatic open-label, two-arm parallel cluster-randomized pilot trial in primary care
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Autoren
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Peter Konstantin Kurotschka
- Universitätsklinikum Würzburg (UKW), Institut für Allgemeinmedizin, Würzburg, Deutschland
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Gabor Borgulya
- Universitätsklinikum Würzburg (UKW), Institut für Allgemeinmedizin, Würzburg, Deutschland
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Eva Bucher
- Universitätsklinikum Würzburg (UKW), Institut für Allgemeinmedizin, Würzburg, Deutschland
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Isabell Endrich
- Universitätsklinikum Würzburg (UKW), Institut für Allgemeinmedizin, Würzburg, Deutschland
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Adolfo Figueiras
- Universidade de Santiago de Compostela, Department of Preventive Medicine and Public Health, Santiago de Compostela, Spanien
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Jochen Stefan Gensichen
- Ludwig-Maximilians-Universität München, Institut für Allgemeinmedizin, München, Deutschland
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Alastair D Hay
- University of Bristol, Academic Unit of Primary Health Care, NIHR National School for Primary Care Research, Department of Community Based Medicine, Bristol, Großbritannien
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Susann Hueber
- Universitätsklinikum Erlangen, Institut für Allgemeinmedizin, Erlangen, Deutschland
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Christian Kretzschmann
- Universitätsklinikum Würzburg (UKW), Institut für Allgemeinmedizin, Würzburg, Deutschland
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Oliver Kurzai
- Julius-Maximilians-Universität Würzburg, Institut für Hygiene und Mikrobiologie, Würzburg, Deutschland
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Thomas Kühlein
- Universitätsklinikum Erlangen, Institut für Allgemeinmedizin, Erlangen, Deutschland
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Thien-Tri Lam
- Julius-Maximilians-Universität Würzburg, Institut für Hygiene und Mikrobiologie, Würzburg, Deutschland
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Orietta Massidda
- Università degli Studi di Trento, Department of Cellular, Computational and Integrative Biology, Center of Medical Sciences (CISMed), Trento, Italien
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Linda Sanftenberg
- Ludwig-Maximilians-Universität München, Institut für Allgemeinmedizin, München, Deutschland
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Guido Schmiemann
- Universität Bremen, Institut für Public Health und Pflegeforschung (IPP), Bremen, Deutschland
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Mark Ebell
- University of Georgia, Department of Epidemiology and Biostatistics, College of Public Health, USA
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Ildiko Gagyor
- Universitätsklinikum Würzburg (UKW), Institut für Allgemeinmedizin, Würzburg, Deutschland
| Veröffentlicht: | 15. September 2022 |
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Gliederung
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Hintergrund: Randomized controlled trials (RCTs) found that non-antibiotic treatment of women with uncomplicated urinary tract infections (unUTIs) increases the risk of longer symptom duration, incomplete recovery, and pyelonephritis. Evidence suggests that point-of-care tests (POCTs) to detect bacteria and erythrocytes in urine at presentation may help general practitioners to select women with unUTIs in whom antibiotics can be withheld without affecting clinical outcomes.
Fragestellung: MicUTI aims to pilot a full-scaled RCT to evaluate the effects on antibiotic use of a diagnosis and treatment algorithm based on phase-contrast microscopy and urinary dipsticks in women with symptoms of an unUTI. It is a pragmatic open-label two-arm cluster-RCT, in which twenty general practices affiliated to the Bavarian Practice Based Research Network in Germany are randomly assigned to deliver patient management based on POCTs or to the usual care arm. Urine samples are obtained at presentation for POCTs and microbiological analysis. Women are followed-up for four weeks through a self-directed patient diary (day 1–7 or until symptom resolution), a telephone call at day 28, and an electronic medical record review in case of missing follow-up information. Primary endpoints are patient enrollment and retention rates. Exploratory endpoints include antibiotic use, time to symptom resolution, symptom burden, the number of recurrent and upper UTIs and re-consultations, and diagnostic accuracy (POCTs vs. urine culture as reference standard).
Diskussionspunkt: The trial centers provide structured training for practice nurses to allow them to perform point-of-care microscopy rapidly and efficiently. Would you like to implement such a POCT for women to manage urinary tract infections? What would be its role in your daily clinical practice?
