Article
Outpatient urinary tract infections in Germany – a cross-sectional study on practices of susceptibility testing in medical laboratories
Ambulante Harnwegsinfektionen in Deutschland – aktuelle Praxis der Resistenzprüfungen von Antibiotika durch Labore
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Authors
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Hannah Bender
- Department of Health Services Research, Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany
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Kathrin Jobski
- Department of Health Services Research, Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany
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Guido Schmiemann
- Department for Health Services Research, Institute of Public Health and Nursing Research (IPP), University of Bremen, Bremen, Germany
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Axel Hamprecht
- Institute of Medical Microbiology and Virology, Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany
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Falk Hoffmann
- Department of Health Services Research, Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany
| Published: | November 13, 2024 |
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Outline
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Background: Urinary tract infections (UTIs) are a common reason for a medical consultation and also a frequent cause for antibiotic prescriptions. The antimicrobial susceptibility tested by laboratories and reported to physicians can directly impact antibiotic prescribing and also guideline adherence in the treatment of UTIs. In Germany, fosfomycin-trometamol, nitrofurantoin, nitroxoline and pivmecillinam are recommended as first-line antibiotics for uncomplicated UTIs. An earlier study from Northern Germany found that microbiological tests often did not include the recommended agents. However, current practices of susceptibility testing by laboratories for outpatient UTIs in Germany are unknown.
Materials and Methods: We conducted a cross-sectional study among all ambulatory medical laboratories in Germany from January to April 2024. Using a standardized questionnaire, we collected data on the tested antibiotics as well as on the communication and exchange of information between outpatient physicians and laboratories.
Results: Overall, 258 of 396 identified laboratories participated in the study (65.2%). Of those, 106 performed susceptibility testing. In a urine culture positive for E. coli, laboratories tested for a mean of 13.1 different antibiotics. With respect to the five antibiotics recommended for uncomplicated UTIs, laboratories performed tests for a mean of 3.8 agents. Overall, the most commonly tested antibiotics were ciprofloxacin (98.1%) and cotrimoxazole (97.2%), followed by cefuroxime and nitrofurantoin (each 91.5%), fosfomycin-trometamol (89.6%) and pivmecillinam (88.7%). A total of 101 laboratories responded to the question which additional information (besides age and sex) they considered important to accompany a urine sample with the most common answers being clinical information, e.g. about pregnancy or immunosuppression (56.4%) and current or previous antibiotic therapy (55.4%). However, when asked to estimate how often they received information on comorbidities and previous treatments, the corresponding proportions were low (21.5% and 21.3%, respectively).
Conclusion: Ambulatory medical laboratories in Germany test for a variety of different antibiotics and they often seem to lack information they consider important. A more detailed and standardized transfer of clinical information from outpatient physicians to laboratories could result in a more targeted selection of tested and reported antibiotics and also improve guideline adherence.
