Pitfalls in diagnosis and management of suspected urinary tract infection in an urban tropical primary care setting

Jackson, Alison Ashe and Lai, Pauline Siew Mei and Alias, Aqtab Mazhar and Atiya, Nadia and Ramdzan, Siti Nurkamilla and Abdul Malik, Tun Firzara and Mydin, Fadzilah Hanum Mohd and Abdul Hadi, Haireen and Othman, Sajaratulnisah (2019) Pitfalls in diagnosis and management of suspected urinary tract infection in an urban tropical primary care setting. The Journal of Infection in Developing Countries, 13 (03). pp. 219-226. ISSN 2036-6590, DOI https://doi.org/10.3855/jidc.11089.

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Official URL: https://doi.org/10.3855/jidc.11089


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. © 2019 Jackson et al.

Item Type: Article
Funders: University of Malaya grant, BKP045-2017
Uncontrolled Keywords: Antibiotic stewardship; Asymptomatic bacteriuria; Diagnosis; Malaysia; Primary care; Urinary tract infection
Subjects: R Medicine
Divisions: Faculty of Medicine
Depositing User: Ms. Juhaida Abd Rahim
Date Deposited: 26 Mar 2020 06:09
Last Modified: 26 Mar 2020 06:09
URI: http://eprints.um.edu.my/id/eprint/24112

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