Pitfalls in diagnosis and management of suspected urinary tract infection in an urban tropical primary care setting
Introduction: Diagnosis and management of urinary tract infection (UTI) are complex, and do not always follow guidelines. The aim of this study was to determine adherence to the 2014 Malaysian Ministry of Health guidelines for managing suspected UTI in a Malaysian primary care setting. Methodolo...
Saved in:
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
The Journal of Infection in Developing Countries
2019-03-01
|
| Series: | Journal of Infection in Developing Countries |
| Subjects: | |
| Online Access: | https://jidc.org/index.php/journal/article/view/11089 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850034362369703936 |
|---|---|
| author | Alison A Jackson Pauline Siew Mei Lai Aqtab Mazhar Alias Nadia Atiya Siti Nurkamilla Ramdzan Tun Firzara Abdul Malik Fadzilah Hanum Mohd Mydin Haireen Abd Hadi Sajaratulnisah Othman |
| author_facet | Alison A Jackson Pauline Siew Mei Lai Aqtab Mazhar Alias Nadia Atiya Siti Nurkamilla Ramdzan Tun Firzara Abdul Malik Fadzilah Hanum Mohd Mydin Haireen Abd Hadi Sajaratulnisah Othman |
| author_sort | Alison A Jackson |
| collection | DOAJ |
| description |
Introduction: Diagnosis and management of urinary tract infection (UTI) are complex, and do not always follow guidelines. The aim of this study was to determine adherence to the 2014 Malaysian Ministry of Health guidelines for managing suspected UTI in a Malaysian primary care setting.
Methodology: We retrospectively reviewed computerized medical records of adults with suspected UTI between July-December 2016. Excluded were consultations misclassified by the search engine, duplicated records of the same patient, consultations for follow-up of suspected UTI, patients who were pregnant, catheterised, or who had a renal transplant. Records were reviewed by two primary care physicians and a clinical microbiologist.
Results: From 852 records, 366 consultations were a fresh episode of possible UTI. Most subjects were female (78.2%) with median age of 61.5 years. The major co-morbidities were hypertension (37.1%), prostatic enlargement in males (35.5%) and impaired renal function (31.1%). Symptoms were reported in 349 (95.4%) consultations. Antibiotics were prescribed in 307 (83.9%) consultations, which was appropriate in 227/307 (73.9%), where the subject had at least one symptom, and leucocytes were raised in urine full examination and microscopic examination (UFEME). In 73 (23.8%) consultations antibiotics were prescribed inappropriately, as the subjects were asymptomatic (14,4.6%), urine was clear (17,5.5%), or UFEME did not show raised leucocytes (42,13.7%). In 7 (2.3%) consultations appropriateness of antibiotics could not be determined as UFEME was not available.
Conclusion: Several pitfalls contributed to suboptimal adherence to guidelines for diagnosis and management of suspected UTI. This illustrates the complexity of managing suspected UTI in older subjects with multiple co-morbidities.
|
| format | Article |
| id | doaj-art-6c75d3e0f4fb4be391b875807ff0095f |
| institution | DOAJ |
| issn | 1972-2680 |
| language | English |
| publishDate | 2019-03-01 |
| publisher | The Journal of Infection in Developing Countries |
| record_format | Article |
| series | Journal of Infection in Developing Countries |
| spelling | doaj-art-6c75d3e0f4fb4be391b875807ff0095f2025-08-20T02:57:52ZengThe Journal of Infection in Developing CountriesJournal of Infection in Developing Countries1972-26802019-03-01130310.3855/jidc.11089Pitfalls in diagnosis and management of suspected urinary tract infection in an urban tropical primary care settingAlison A Jackson0Pauline Siew Mei Lai1Aqtab Mazhar Alias2Nadia Atiya3Siti Nurkamilla Ramdzan4Tun Firzara Abdul Malik5Fadzilah Hanum Mohd Mydin6Haireen Abd Hadi7Sajaratulnisah Othman8Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, MalaysiaDepartment of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, MalaysiaDepartment of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, MalaysiaDepartment of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, MalaysiaDepartment of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, MalaysiaDepartment of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, MalaysiaDepartment of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, MalaysiaDepartment of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, MalaysiaDepartment of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia Introduction: Diagnosis and management of urinary tract infection (UTI) are complex, and do not always follow guidelines. The aim of this study was to determine adherence to the 2014 Malaysian Ministry of Health guidelines for managing suspected UTI in a Malaysian primary care setting. Methodology: We retrospectively reviewed computerized medical records of adults with suspected UTI between July-December 2016. Excluded were consultations misclassified by the search engine, duplicated records of the same patient, consultations for follow-up of suspected UTI, patients who were pregnant, catheterised, or who had a renal transplant. Records were reviewed by two primary care physicians and a clinical microbiologist. Results: From 852 records, 366 consultations were a fresh episode of possible UTI. Most subjects were female (78.2%) with median age of 61.5 years. The major co-morbidities were hypertension (37.1%), prostatic enlargement in males (35.5%) and impaired renal function (31.1%). Symptoms were reported in 349 (95.4%) consultations. Antibiotics were prescribed in 307 (83.9%) consultations, which was appropriate in 227/307 (73.9%), where the subject had at least one symptom, and leucocytes were raised in urine full examination and microscopic examination (UFEME). In 73 (23.8%) consultations antibiotics were prescribed inappropriately, as the subjects were asymptomatic (14,4.6%), urine was clear (17,5.5%), or UFEME did not show raised leucocytes (42,13.7%). In 7 (2.3%) consultations appropriateness of antibiotics could not be determined as UFEME was not available. Conclusion: Several pitfalls contributed to suboptimal adherence to guidelines for diagnosis and management of suspected UTI. This illustrates the complexity of managing suspected UTI in older subjects with multiple co-morbidities. https://jidc.org/index.php/journal/article/view/11089antibiotic stewardshipasymptomatic bacteriuriadiagnosisMalaysiaprimary careurinary tract infection |
| spellingShingle | Alison A Jackson Pauline Siew Mei Lai Aqtab Mazhar Alias Nadia Atiya Siti Nurkamilla Ramdzan Tun Firzara Abdul Malik Fadzilah Hanum Mohd Mydin Haireen Abd Hadi Sajaratulnisah Othman Pitfalls in diagnosis and management of suspected urinary tract infection in an urban tropical primary care setting Journal of Infection in Developing Countries antibiotic stewardship asymptomatic bacteriuria diagnosis Malaysia primary care urinary tract infection |
| title | Pitfalls in diagnosis and management of suspected urinary tract infection in an urban tropical primary care setting |
| title_full | Pitfalls in diagnosis and management of suspected urinary tract infection in an urban tropical primary care setting |
| title_fullStr | Pitfalls in diagnosis and management of suspected urinary tract infection in an urban tropical primary care setting |
| title_full_unstemmed | Pitfalls in diagnosis and management of suspected urinary tract infection in an urban tropical primary care setting |
| title_short | Pitfalls in diagnosis and management of suspected urinary tract infection in an urban tropical primary care setting |
| title_sort | pitfalls in diagnosis and management of suspected urinary tract infection in an urban tropical primary care setting |
| topic | antibiotic stewardship asymptomatic bacteriuria diagnosis Malaysia primary care urinary tract infection |
| url | https://jidc.org/index.php/journal/article/view/11089 |
| work_keys_str_mv | AT alisonajackson pitfallsindiagnosisandmanagementofsuspectedurinarytractinfectioninanurbantropicalprimarycaresetting AT paulinesiewmeilai pitfallsindiagnosisandmanagementofsuspectedurinarytractinfectioninanurbantropicalprimarycaresetting AT aqtabmazharalias pitfallsindiagnosisandmanagementofsuspectedurinarytractinfectioninanurbantropicalprimarycaresetting AT nadiaatiya pitfallsindiagnosisandmanagementofsuspectedurinarytractinfectioninanurbantropicalprimarycaresetting AT sitinurkamillaramdzan pitfallsindiagnosisandmanagementofsuspectedurinarytractinfectioninanurbantropicalprimarycaresetting AT tunfirzaraabdulmalik pitfallsindiagnosisandmanagementofsuspectedurinarytractinfectioninanurbantropicalprimarycaresetting AT fadzilahhanummohdmydin pitfallsindiagnosisandmanagementofsuspectedurinarytractinfectioninanurbantropicalprimarycaresetting AT haireenabdhadi pitfallsindiagnosisandmanagementofsuspectedurinarytractinfectioninanurbantropicalprimarycaresetting AT sajaratulnisahothman pitfallsindiagnosisandmanagementofsuspectedurinarytractinfectioninanurbantropicalprimarycaresetting |