Urine cultures and antibiotics for urinary tract infections in Dutch general practice.

Background: Urinary tract infections (UTIs) are common in general practice, and antibiotic resistance is often seen. Urine cultures are advised by the Dutch national UTI guideline for patients at high risk of UTI complications. Prudent use of antibiotics and taking into account national guidelines and urine culture results are important to combat antibiotic resistance in general practice. Aim: To identify subgroups of UTI patients in which the use of urine cultures and antibiotic prescriptions deviates from the national guidelines. Methods: We investigated associations of several characteristics with urine culture orders in patients with UTI in 2015 from seven Dutch general practices (n = 1295). These included subgroups at risk for UTI complications, comorbidities, age and history of UTI recurrence. In addition, we assessed the level of adherence to the guideline for antibiotic prescriptions in subgroups at risks for UTI complications. Findings: Urine cultures were ordered in 17% (n = 221) of patients, more frequently in high-risk patients (32%) than in low-risk patients (7%), for UTI complications (OR = 6.4; 95% CI 4.6-9.0). In low-risk patients, 91% received antibiotics that were recommended in the guideline. For high-risk patients this percentage ranged widely, and was particularly low in the risk groups with signs of tissue invasion (29-50%). Diagnostic and therapeutic adequacy can still be improved by increasing the adherence to the guideline in UTI patients at high risk for complications. This may contribute to containing antibiotic resistance in UTI by ordering urine cultures and use the results to adjust prescriptions to antibiotic susceptibility of the uropathogen.