Availability of point-of-care culture and microscopy in general practice - does it lead to more appropriate use of antibiotics in patients with suspected urinary tract infection?

Abstract

Background

Urinary tract infection (UTI) is a common condition in general practice, and urine culture can help reduce inappropriate antibiotic prescriptions. In case of delay of the result, antibiotic treatment can be guided by one or more point-of-care (POC) tests. In Denmark, POC microscopy and POC urine culture are widely used for this purpose.

Objectives

To investigate if availability of POC microscopy or POC culture in general practice was associated with a more appropriate treatment decision in patients with suspected UTI while waiting for the result from the microbiological laboratory.

Methods

This prospective observational study was conducted in 2016 in general practice in the Copenhagen area, Denmark. Data on all patients presenting in general practice with symptoms of UTI were registered anonymously and a urine sample was sent for culture at the microbiological laboratory. The association between the availability of POC tests and the appropriateness of antibiotic prescribing was assessed with multivariable logistic regression.

Results

Seventy-six general practices included 1545 patients (83% female); 71% received appropriate treatment in practices with POC culture available and 65% in practices without POC culture available (p = 0.042). Having a microscope available was not associated with more appropriate treatment (70% vs. 69%, p = 0.54).

Conclusion

Availability of POC culture marginally increased appropriate treatment while waiting for the result from the microbiological laboratory. Practices should adopt a strategy where they either perform culture within the practice or send urine for culture at the microbiological laboratory.

Trial registration number

ClinicalTrials.gov NCT02698332.

Keywords:

• Urinary tract infections
• microscopy
• culture media
• point-of-care testing
• general practice

Acknowledgements

We want to thank the GPs and patients who took part in this study, as well as the UC-Care Research Centre at the University of Copenhagen, Denmark.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This study was funded by: (a) 2016, University of Copenhagen; (b) Læge Sofus Carl Emil Friis og Hustru Olga Doris Friis’ legat.