Sep 26: Optimization of the management of complicated UTI
Urinary tract infection (UTI) is a common bacterial infection, often seen in risk-groups like long-term care (LTC) residents, but one third of prescriptions might be unnecessary. Due to comorbidities like cognitive problems and lack of a reliable diagnostic test, UTI can be difficult to diagnose. Still, overuse of antibiotics can result in side-effects and antibiotic resistance.
Educational program
In her thesis, Kelly Hendriks (Julius Center for Health Science and Primary Care, UMC Utrecht) and colleagues tried to improve antibiotic prescribing for UTI in long-term care (LTC) facilities by introducing an educational program based on the Dutch guideline for UTI in fragile older adults.
Key findings
- The investigators showed that while antibiotic treatment-days did not decrease during the intervention, there was a decrease in the number of prescriptions for UTI. Additionally, the study showed that the intervention resulted in less antibiotic treatment in residents with non-specific complaints.
- In the search to find an alternative to current diagnostic tests for UTI in LTC residents, the investigators studied two tests that can be performed near the patient (“point-of-care”). Both tests lacked accuracy in recognizing UTI-pathogens and their susceptibility patterns, which could result in overtreatment.
- Finally, they studied the treatment duration of UTI in women with diabetes mellitus and found that the risk of recurrent UTI of women with diabetes mellitus was not clinically significantly increased in women treated with nitrofurantoin for 5 days instead of guideline-advised 7 days.
In summary, while optimising antibiotic treatment can be difficult due to complicated diagnostics or limited studies on treatment duration, in the coming years it remains an important topic to further reduce development of antibiotic resistance.
PhD defense
Kelly Hendriks (1987, Oosterhout) defended her PhD thesis on September 26, 2022 at Utrecht University. The title of her thesis is “Optimization of the management of complicated UTI.” Supervisors were prof. dr. Theo Verheij (Department of General Practice, UMC Utrecht) and prof. dr. Marc Bonten (Research Program Epidemiology of Infectious Diseases, UMC Utrecht). Co-supervisors were dr. Wendelien Dorigo-Zetsma (Tergooi Medisch Centrum) and dr. Henri van Werkhoven (Research Program Epidemiology of Infectious Diseases, UMC Utrecht). In May 2022, Kelly started her residency in internal medicine at the Ikazia hospital in Rotterdam, under the supervision of Drs. Marike Wabbijn (Ikazia Hospital) and Dr. Adrienne Zandbergen (Erasmus MC).