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Make a choice dr. M.H. Blanker Dr. H. van der Worp dr. M.S. Berends

Project properties

Title	Management of urinary tract infections in Dutch and German primary care and the influence on the prevalence of antibiotic resistance.
Keywords	antibiotics urinary tract infection Antimicrobial resistance
Researchers	dr. M.H. Blanker Dr. H. van der Worp dr. M.S. Berends
Type of project	Stage Wetenschap / Researchproject
Nature of the research	Prospective observational study in Dutch general practices
Fields of study	epidemiology GP medicine microbiology

Background / introduction

Treatment options of infectious diseases including antibiotic prescriptions differ not only between countries worldwide, but also between neighbouring countries such as Germany and the Netherlands. The differences may be caused by structural differences (e.g. number of general practitioners (GPs) per population and their accessibility) or different healthcare policies (e.g. requirements regarding certificates of disability leading to higher utilization of primary care). Moreover, communication between microbiologists and GPs may also vary depending on the accessibility and existing structures. Last but not least, differences in the type of diagnostic and microbiological diagnostic frequency (MDF) might also be one of the causes. Within the framework of this subproject, special emphasis will be given to urinary tract infections (UTI) as these are among the most frequent infectious diseases in primary care and one of the main reason for antibiotic prescription. The cross-border region presents as a natural ‘living lab’ to study the aforementioned similarities and differences in a natural cohort.

Research question / problem definition
This project aims to explore differences and similarities in the management and treatment of UTIs in primary care in the Ems-Dollart region. The focus will be on diagnostics and treatment for patients with UTI including the determination of the MDF and the prevalence of antibiotic-resistant pathogens isolated from UTIs.

Workplan

This subproject will collect data on the Dutch side of the border. In each participating practice, for a two-week period, all consecutive women with symptoms suggestive of a UTI, are included (these cases will be indicated by the GP). This short period is chosen to lower the burden of participation in this study for the practices. All patients receive care as usual consisting of completing a questionnaire about their UTI complaints, and providing a urine sample. Basic diagnostics are applied (i.e. urine dipstick test and dipslide), according to the current guidelines, and treatment choices are made by the GP/patient. For the purpose of this study, irrespective of the current guideline and GP choices, urine samples of all patients are sent to the laboratory for urine culture (the gold standard for UTI diagnosis) and sediment. After one week, data are collected on the eventual treatment choice of the patient, the GP prescribed treatment, self-management advice and the course of the symptoms. For this, patients are asked to fill in a short follow up questionnaire that is given to them on paper at the first meeting to the GP. Data collection on the diagnostic strategy used by the GP will include the following: history-taking, urine dipstick, urine sediment, dipslide, and urine culture. Different combinations of these diagnostic tests are defined as separate diagnostic strategies.