Variation in presentation, microbiology, antibiotic prescribing, and patient outcomes of uncomplicated urinary tract infection: a prospective four-country primary care observational cohort study

Aim: To describe presentation and management of urinary tract infection in primary care settings, and explore the association with patient recovery, taking microbiological findings and case mix into account.Design and setting: Prospective observational study of women with symptoms of uncomplicated UTI presenting to primary care networks in England, Wales, the Netherlands, and Spain.Method: Clinicians recorded history, symptom severity, management, and requested mid-stream urine culture. Participants recorded symptom severity each day for 14 days in a diary. Time to recovery was compared between patient characteristics and between countries using two-level Cox proportional hazards models, with patients nested within practices.Results: 797 women attending primary care networks in England (246 (30·9%)), Wales (213 (26·7%)), the Netherlands (133 (16·7%)) and Spain (205 (25·7%)) were included. 259 (35·7%, 95% CI 32·3 to 39·2) were urine culture positive for UTI. Pathogens and antibiotic sensitivities were similar. Empirical antibiotics were prescribed for > 90% of women in England, Wales and Spain, but lower in the Netherlands. There were no meaningful differences at a country network level before and after controlling for severity, prior UTIs, and antibiotic prescribing.Conclusion: Variation in presentation and management of uncomplicated UTI at a country primary care network level is clinically unwarranted and highlights lack of consensus concerning optimal symptom control and antibiotic .prescribing.