Research Summary
Background
Urinary tract infections (UTIs) are common, leading to significant patient morbidity. It is estimated three percent of women who develop a UTI will develop recurrent UTIs. (1)
Butler CC, Hawking MKD, Quigley A, McNulty CAM. Incidence, Severity, Help Seeking, And Management Of Uncomplicated Urinary Tract Infection: A Population-Based Survey. Br J Gen Pract. 2015;65(639):E702–7.
Recurrent UTIs are defined as two UTIs in six months or three within 12 months. The mainstay of treatment for recurrent UTIs are prophylactic antibiotics and the concern is their impact on antimicrobial resistance (AMR).
Resistant UTIs cause prolonged and more severe symptoms, impact on daily living, with increased costs and workload to primary care. (2) (3) Alternative non-antibiotic options exist but how they compare relative to each other in effectiveness is unknown.
Urinary tract infections (UTIs) are common, leading to significant patient morbidity. It is estimated three percent of women who develop a UTI will develop recurrent UTIs (1) .
Recurrent UTIs are defined as two UTIs in six months or three within 12 months. The mainstay of treatment for recurrent UTIs are prophylactic antibiotics and the concern is their impact on antimicrobial resistance (AMR).
Resistant UTIs cause prolonged and more severe symptoms, impact on daily living, with increased costs and workload to primary care (2) (3) . Alternative non-antibiotic options exist but how they compare relative to each other in effectiveness is unknown.
Aim
The aim of this research is to enhance understanding about recurrent UTI management and to improve shared decision-making about the use of prophylactic antibiotics for women with recurrent UTI.
Methods
This project will involve four work packages:
Work-package 1 |
This work-package consists of a systematic review and network meta-analysis to compare the relative effectiveness of the various treatments for recurrent UTIs. We will also undertake a qualitative evidence synthesis and meta-ethnography of the impact of recurrent UTIs on patients and patients’ and clinicians’ views on the management of recurrent UTIs.
This work-package consists of a systematic review and network meta-analysis to compare the relative effectiveness of the various treatments for recurrent UTIs. We will also undertake a qualitative evidence synthesis and meta-ethnography of the impact of recurrent UTIs on patients and patients’ and clinicians’ views on the management of recurrent UTIs.
Work-package 2 |
The second work package will use anonymised GP patient data from the Secure Anonymised Information Linkage (SAIL) Databank. We will describe the prevalence of women in Wales with recurrent UTIs and the use of long-term antibiotic prophylaxis. Then patients with recurrent UTIs identified taking long-term antibiotic prophylaxis will be compared to those not taking antibiotics for the development of antimicrobial resistance. AMR.
Work-package 3 |
Work-package 3 will involve focus groups with patients and semi-structured interviews with clinicians to develop content and design the decision aid according to internationally agreed development standards.
Work-package 3 will involve focus groups with patients and semi-structured interviews with clinicians to develop content and design the decision aid according to internationally agreed development standards.
Work-package 4
An early decision aid prototype will be created based on the above work-packages and undergo early user-testing with patients using the ‘Think aloud’ technique.
An early decision aid prototype will be created based on the above work-packages and undergo early user-testing with patients using the ‘Think aloud’ technique.
Work-package 1
This work-package consists of a systematic review and network meta-analysis to compare the relative effectiveness of the various treatments for recurrent UTIs. We will also undertake a qualitative evidence synthesis and meta-ethnography of the impact of recurrent UTIs on patients and patients’ and clinicians’ views on the management of recurrent UTIs.
Work-package 2
The second work package will use anonymised GP patient data from the Secure Anonymised Information Linkage (SAIL) Databank. We will describe the prevalence of women in Wales with recurrent UTIs and the use of long-term antibiotic prophylaxis. Then patients with recurrent UTIs identified taking long-term antibiotic prophylaxis will be compared to those not taking antibiotics for the development of antimicrobial resistance. AMR.
Work-package 3
Work-package 3 will involve focus groups with patients and semi-structured interviews with clinicians to develop content and design the decision aid according to internationally agreed development standards.
Work-package 4
An early decision aid prototype will be created based on the above work-packages and undergo early user-testing with patients using the ‘Think aloud’ technique.
References
(1)
Butler CC, Hawking MKD, Quigley A, McNulty CAM. Incidence, Severity, Help Seeking, And Management Of Uncomplicated Urinary Tract Infection: A Population-Based Survey. Br J Gen Pract. 2015;65(639):E702–7.
(2)
Butler CC, Hillier S, Roberts Z, Dunstan F, Howard A, Palmer S. Antibiotic-resistant infections in primary care are symptomatic for longer and increase workload: Outcomes for patients with E. coli UTIs. Br J Gen Pract. 2006;56(530):686–92.
(3)
Alam MF, Cohen D, Butler C, Dunstan F, Roberts Z, Hillier S, et al. The additional costs of antibiotics and re consultations for antibiotic-resistant Escherichia coli urinary tract infections managed in general practice. Int J Antimicrob Agents. 2009;33(3):255–7.