Urinary Tract Infections in General Practice: Diagnostic strategies, bacteriology, and treatment options for multi-resistant bacteria

Urinary tract infections are commonly handled in primary care. The thesis explored diagnostic strategies and bacteriology of uncomplicated urinary tract infections. A possible narrow-spectrum antibiotic treatment for urinary tract infections caused by extended spectrum β-lactamase (ESBL) producing E. coli was also evaluated. The data were collected by reviewing medical records, performing structured interviews and using self-report questionnaires. A validated and standardised clinical registration form was found to be a safe method to identify women with uncomplicated urinary tract infections who were likely to respond to antibiotic treatment. Stronger symptoms did not correlate with significant bacteriuria at presentation or protracted duration of symptoms following empiric treatment. However, strong symptoms could still be an indication for immediate antibiotics due to discomfort. Nitrofurantoin and pivmecillinam were found to be appropriate first choice agents for empiric treatment of uncomplicated urinary tract infections, and increased consumption of pivmecillinam had not caused marked increase in resistance rates for E. coli. ESBL producing isolates demonstrated marked co-resistance to several oral treatment options. However, pivmecillinam treatment in dosage of 400 mg x 3 was deemed a viable treatment option for community acquired urinary tract infections caused by ESBL producing E. coli. The findings suggest that a commonly used, narrow spectrum antibiotic can be used as an oral treatment option for multi-resistant bacteria causing urinary tract infections. This can possibly avoid hospitalisation of affected persons and reduce future resistance rates.