A randomized controlled trial of a diagnostic algorithm for symptoms of uncomplicated cystitis at an out-of-hours service

Figures & data

Figure 1. Diagnostic algorithm.

Figure 2. Trial flow chart: RCT of diagnostic algorithm for uncomplicated cystitis at an Out-of-hours service in Oslo, Norway.

Figure 3. Symptom resolution: Percentage of patients with remaining symptoms versus number of days since the start of treatment, Kaplan–Meier plot. Blue line: Treated according to the diagnostic algorithm. Green line: Treatment chosen after a doctor's consultation. P-value (log rank): 0.3.

Table I. Baseline demographic and clinical characteristics of consecutive female patients presenting with symptoms of urinary tract infection at an out-of-hours service in Oslo, Norway.

	Diagnostic algorithm (n = 242)	Doctor's consult (n = 191)	p-value
Age, mean (SD), y	27 (8)	27 (8)	NS
Country of origin
Norwegian, n, (%)	206 (85)	159 (83)	NS
Other European, n, (%)	25 (10)	27 (14)	NS
Outside Europe, n, (%)	9 (4)	4 (2)	NS
Unknown, n, (%)	2 (1)	1 (1)	NS
Patient-reported symptoms
Painful urination
Strong, n (%)	85 (35)	48 (25)	NS
Moderate, n (%)	126 (52)	111 (58)	NS
Mild, n (%)	31 (13)	32 (17)	NS
Increased frequency of urination
Strong, n (%)	89 (37)	64 (34)	NS
Moderate, n (%)	132 (54)	110 (58)	NS
Mild, n (%)	21 (9)	17 (9)	NS
Increased need to urinate, n (%)	237 (98)	190 (99)	0.07
Macroscopic haematuria, n (%)	92 (38)	78 (41)	NS
Urinary dipstick findings	n = 160	n = 187
Nitrate positive, n (%)	29 (18)	29(16)	NS
Leukocyte esterase positive n (%)	141(88)	164(88)	NS

Notes: Crosstabs analysis. Pearson's chi-square p-value. NS = non-significant. p < 0.15 stated.

Table II. Bacteriological findings in urine samples of female patients presenting with symptoms of urinary tract infection at an out-of-hours service in Oslo, Norway.

	Diagnostic algorithm	Doctor's consultation	p-value
Urine samples taken at consultation, n	234	172
Negative culture, n (%)^1	102 (44)	71 (41)	NS
Single culture isolates, n (%)^2	132 (56)	101 (59)	NS
Primary pathogens:
Escherichia coli, n (%)	101 (77)	79 (78)	NS
Staphylococcus saprophyticus, n (%)	21 (16)	17 (17)	NS
Secondary pathogens:
Klebsiella species, n (%)	3 (2)	2 (2)	NS
Proteus mirabilis, n (%)	4 (3)	0	NS
Enterococcus fecalis, n (%)	1 (1)	1 (1)	NS
Enterobacter species, n (%)	0	1 (1)	NS
Doubtful pathogens:
Streptococcus agalactiae, n (%)	2 (2)	0	NS
Pseudomonas species, n (%)	0	1 (1)	NS
Control urine sample, n (% of total)	169 (78)	130 (76)
Negative culture, n (%)^1	150 (89)	117 (90)	0.13
Single culture isolates, n (%)^2	19 (11)	13 (10)	NS

Notes: Crosstabs analysis. Pearson's chi-square p-value. NS = non-significant. p < 0.15 stated. Patients who did not deliver primary or control urine samples were excluded. ¹Non-significant bacteriuria, see Material and methods. ²All species-specific percentage values are calculated for the total number of single-culture isolates.