Keywords: Urinary tract infection; resistance rate; susceptibility; feedback
Introduction:
Urinary tract infections (UTIs) are among the most common reasons for prescribing antibiotics in primary care. In selected cases, guidelines recommend further testing of pathogens and their antimicrobial susceptibility. Which antibiotics are tested by laboratories and reported to physicians can influence antibiotic prescribing. Previous studies suggest that laboratory testing often does not include guideline-recommended antibiotics. However, the current practice of laboratory susceptibility testing for outpatient urinary tract infections in Germany is unknown and should be assessed in the study.
Method:
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%). Laboratories wished for additional information they considered important to accompany a urine sample. 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).
Conclusions:
Outpatient medical laboratories in Germany test for a variety of different antibiotics and they often seem to lack information they consider important, Only some of the antibiotics recommended in guidelines are included in laboratory analysis. Perhaps a more targeted selection of antibiotics tested and reported could improve adherence to guidelines.
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