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Title: Uncomplicated urinary tract infection in primary care : evaluation of point of care tests and patient management
Author: Bongard, Emily
ISNI:       0000 0004 5371 0276
Awarding Body: Cardiff University
Current Institution: Cardiff University
Date of Award: 2015
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Antibiotic resistance is an increasing global public health problem. Resistance is increasing sharply in gram-negative organisms, including Escherichia coli (E. coli), the main causative organism for community-acquired urinary tract infection (UTI). Antimicrobial stewardship strategies in primary care to help contain antibiotic resistance include supporting general practitioners (GPs) in deciding whether to prescribe an antibiotic for UTI and selecting the most appropriate antibiotic. In this thesis, I aim to describe the management of uncomplicated UTI in primary care and evaluate potential point of care tests (POCT) to assist the diagnosis and/or appropriate prescribing of antibiotics for uncomplicated UTI. The program of work includes: 1. Laboratory evaluation of a culture-based test that allows the quantification, identification and susceptibility profile of infecting bacteria from urine (FlexicultTM). 2. Evaluation of a novel chromatic sensing technique to identify bacterially infected urine compared to visual assessment of urine turbidity and urinalysis dipsticks. 3. Systematic review and analysis of data (descriptive and multi-level modelling) from an international primary care based observational study to describe UTI management. I identified unwarranted variation in clinical management of UTI between countries and between general practices within countries. Empirical antibiotic prescribing for UTI in Europe is high and treatment is generally prescribed for longer than guidelines recommend. FlexicultTM identifying bacterial UTI. The use of FlexicultTM in practice may support GPs in screening out negative samples reducing the proportion of patients that are prescribed antibiotics empirically. Chromatic sensing and visually assessing turbidity were equally useful at identifying negative urine samples and both improved the analytic performance of urinalysis dipsticks. The chromatic sensing system requires development prior to further evaluation.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: R Medicine (General)