Programme no. 339-OP
Quality Improvement
Women with urinary tract infection (UTI) - Who needs antibiotics and who does not?
Ildiko Gagyor*1, Guido Schmiemann2, Jutta Bleidorn3, Karl Wegscheider4, Eva Hummers-Pradier5
1Department of General Practice,University Medical Center, University of Göttingen,Göttingen,Germany, 2Institute for Public Health and Nursing Science,University of Bremen,Bremen,Germany, 3Department of General Practice,Hanover Medical School,Hanover,Germany, 4Department of Medical Biometry and Epidemiology,University Medical Centre Hamburg-Eppendorf,Hamburg,Germany, 5Department of General Practice,University Medical Center, University of Göttingen,Göttingen,Germany
* = Presenting author
Objectives: The aim of this study was to identify determinants for a self-limiting course of UTI, i.e. for recovering without antibiotic treatment by analysing the ibuprofen group of the ICUTI trial.
Background: Though potential self-limiting, urinary tract infections are usually treated with antibiotics. In a randomised-controlled trial ICUTI - (Immediate versus conditional treatment for UTI) we showed that an initial symptomatic treatment of UTI with ibuprofen (antibiotics only if needed) can reduce the number of antibiotic courses without harm. We hypothesized that women recovering without antibiotics have different characteristics than women who needed an antibiotic treatment.
Results: Of 241 women in the ibuprofen group 85 (35%) needed antibiotic prescription within 28 days of study period, of whom 75 (31%) prescriptions were UTI-related. A self-limiting course of UTI had 156 women. The preliminary results show that women recovering without antibiotics were slightly younger (36.3 years; SD ±14.4 vs. 39.3; ±15), and more of them had recurrent UTI (18.7% vs. 14.7%). The number of positive urine cultures was significantly higher in those who needed antibiotics (93.3% vs. 67.7%; p<0.001). Complete results will be presented at Nordic Conference.
Material/Methods: In ICUTI, 494 women presenting with symptoms of uncomplicated UTI were randomised to receive either ibuprofen 3x 400mg for three days and antibiotics only if needed or immediate antibiotic treatment with fosfomycin-trometamol 1x3 g. To assess symptom relief and antibiotic prescriptions, follow-up calls were conducted on day 1,3,5,7 and 28. To determine factors associated with recovering without antibiotics, baseline data of women in the ibuprofen group with and without secondary antibiotic treatment will be analysed using multiple logistic regression analysis. Odds ratios (ORs) and their 95% confidence intervals (CI) will be calculated as measures of effect size.
Conclusion: Preliminary results show that age, recurrent UTI and positive urine culture seem to be predictors for women who need antibiotic treatment in UTI. By spring 2015 we will be able to further determine factors associated with recovery without antibiotics in UTI.
Points for discussion: If any factors associated with no need of antibiotics in women with UTI can be found, how can results be used for practice?