Urine culture doubtful in determining etiology of diffuse symptoms

Background: As many as half of elderly residents at nursing homes have asymptomatic bacteriuria. Thus it’s hard to know if a new symptom is related to findings of bacteria in urine or not. There are different opinions on the possible connection between different non-specific symptoms and urinary tract infections (UTI). Non-specific symptoms in combination with diagnostic uncertainty often lead to antibiotic treatments of uncertain value. Antibiotic overuse increases the prevalence of antibiotic resistant bacteria. Research question: What is the relationship between bacteria in the urine and new or increased fatigue, confusion, restlessness, aggressiveness, not being herself/himself, dysuria, urgency and fever. Methods: In this cross-sectional study symptoms were registered and voided urine specimens collected for urine cultures from 651 elderly residents in 32 nursing homes located in south-western Sweden. Correlation between bacteriuria and presence of a symptom at group level were determined using logistic regression. To estimate the clinical relevance of correlations at group level positive and negative etiological predictive values (EPV) were calculated. EPV takes into account the presence of asymptomatic bacteriuria. Results: In this study 207/651 (32%) of urine cultures were positive. Fatigue, restlessness and confusion were the most common symptoms. Logistic regression indicated some correlations at group level. Aside from Escherichia coli in the urine and not being herself/himself present for at least one month, but less than three months, EPV indicated no clinically useful correlation between any symptoms in this study and findings of bacteriuria. Conclusion: Urine cultures are insufficiently specific when evaluating elderly patients at nursing homes presenting with new or increased restlessness, fatigue, confusion, aggressiveness, dysuria or urgency

Urine culture doubtful in determining etiology of diffuse symptoms

Background: As many as half of elderly residents at nursing homes have asymptomatic bacteriuria. Thus it’s hard to know if a new symptom is related to findings of bacteria in urine or not. There are different opinions on the possible connection between different non-specific symptoms and urinary tract infections (UTI). Non-specific symptoms in combination with diagnostic uncertainty often lead to antibiotic treatments of uncertain value. Antibiotic overuse increases the prevalence of antibiotic resistant bacteria. Research question: What is the relationship between bacteria in the urine and new or increased fatigue, confusion, restlessness, aggressiveness, not being herself/himself, dysuria, urgency and fever. Methods: In this cross-sectional study symptoms were registered and voided urine specimens collected for urine cultures from 651 elderly residents in 32 nursing homes located in south-western Sweden. Correlation between bacteriuria and presence of a symptom at group level were determined using logistic regression. To estimate the clinical relevance of correlations at group level positive and negative etiological predictive values (EPV) were calculated. EPV takes into account the presence of asymptomatic bacteriuria. Results: In this study 207/651 (32%) of urine cultures were positive. Fatigue, restlessness and confusion were the most common symptoms. Logistic regression indicated some correlations at group level. Aside from Escherichia coli in the urine and not being herself/himself present for at least one month, but less than three months, EPV indicated no clinically useful correlation between any symptoms in this study and findings of bacteriuria. Conclusion: Urine cultures are insufficiently specific when evaluating elderly patients at nursing homes presenting with new or increased restlessness, fatigue, confusion, aggressiveness, dysuria or urgency

Association between guidelines and medical practitioners' perception of best management for patients attending with an apparently uncomplicated acute sire throat: a cross-sectional survey in five countries

Objective To investigate the relationship between guidelines and the medical practitioners' perception of optimal care for patients attending with an apparently uncomplicated acute sore throat in five countries (Australia, Germany, Sweden, UK and USA). Design International cross-sectional survey. Setting Primary healthcare (PHC). Participants Medical practitioners working in PHC. Main outcome measures ORs for: (A) perception of throat swabs as important, (B) perception of blood tests (C reactive protein, B-ESR and B-leucocytes) as important and (C) antibiotic prescriptions if no pathogenic bacteria isolated on throat swab. Results Guidelines differed significantly; those recommending throat swabs (Sweden and USA) were associated with practitioners perceiving them as important. The UK guideline was the only one actively discouraging the use of throat swabs. Hence, compared with the USA (reference), a throat swab showing no pathogenic bacteria increased the probability of antibiotic prescribing in the UK with OR 3.2 (95% CI 1.7 to 6.1) for adults, whereas it reduced the probability in Sweden for adults OR 0.35 (95% CI 0.13 to 0.96) and children 0.19 (95% CI 0.069 to 0.50). Conclusions The differences between practitioners' perceptions of best management were associated with their guidelines. It remains unclear if guidelines influenced medical practitioners' perception or if guidelines merely reflect the consensus of current practice. A larger effort should be made to reach an international consensus in high-income countries about the best management of patients attending for an uncomplicated acute sore throat

In primary health care, never prescribe antibiotics to patients suspected of having an uncomplicated sore throat caused by group A beta-haemolytic streptococci without first confirming the presence of this bacterium

Background: There are several consensus-describing decision rules for patients in primary health care with a sore throat. The objective of this study was to estimate the number of unnecessary antibiotic prescriptions in primary health care given to patients with a sore throat, due to these different decision rules. A further aim was to suggest revised rules for decision-making in primary health care, when a sore throat caused by group A beta-haemolytic streptococci (GAS) is suspected. Methods: The design was a reanalysis of previously published articles describing the prevalence of GAS and physician behaviour when treating patients with a sore throat. The risk of unnecessary antibiotic prescribing in different situations was estimated and applied to the Swedish population. Results: Introducing the rule of never prescribing antibiotics without first confirming the presence of GAS would result in an annual reduction in Sweden of 20,360-25,192 unnecessary antibiotic prescriptions in children and 65,311-98,160 in adults. Conclusions: The single most important rule in primary health care to minimize the risk of unnecessary antibiotic prescription to patients with an uncomplicated sore throat, and where an infection with GAS is suspected, is to never prescribe antibiotics at the first visit without first confirming the presence of this bacterium. Adding more decision rules may to some extent further reduce the number of unnecessary antibiotic prescriptions

Penicillin V four times daily for five days versus three times daily for 10 days in patients with pharyngotonsillitis caused by group A streptococci: randomised controlled, open label, non-inferiority study

OBJECTIVE To determine whether total exposure to penicillin V can be reduced while maintaining adequate clinical efficacy when treating pharyngotonsillitis caused by group A streptococci. DESIGN Open label, randomised controlled non-inferiority study. SETTING 17 primary healthcare centres in Sweden between September 2015 and February 2018. PARTICIPANTS Patients aged 6 years and over with pharyngotonsillitis caused by group A streptococci and three or four Centor criteria (fever amp;gt;= 38.5 degrees C, tender lymph nodes, coatings of the tonsils, and absence of cough). INTERVENTIONS Penicillin V 800 mg four times daily for five days (total 16 g) compared with the current recommended dose of 1000 mg three times daily for 10 days (total 30 g). MAIN OUTCOMES MEASURES Primary outcome was clinical cure five to seven days after the end of antibiotic treatment. The noninferiority margin was prespecified to 10 percentage points. Secondary outcomes were bacteriological eradication, time to relief of symptoms, frequency of relapses, complications and new tonsillitis, and patterns of adverse events. RESULTS Patients (n=433) were randomly allocated to the five day (n=215) or 10 day (n=218) regimen. Clinical cure in the per protocol population was 89.6% (n=181/202) in the five day group and 93.3% (n=182/195) in the 10 day group (95% confidence interval -9.7 to 2.2). Bacteriological eradication was 80.4% (n=156/194) in the five day group and 90.7% (n=165/182) in the 10 day group. Eight and seven patients had relapses, no patients and four patients had complications, and six and 13 patients had new tonsillitis in the five day and 10 day groups, respectively. Time to relief of symptoms was shorter in the five day group. Adverse events were mainly diarrhoea, nausea, and vulvovaginal disorders; the 10 day group had higher incidence and longer duration of adverse events. CONCLUSIONS Penicillin V four times daily for five days was noninferior in clinical outcome to penicillin V three times daily for 10 days in patients with pharyngotonsillitis caused by group A streptococci. The number of relapses and complications did not differ between the two intervention groups. Five day treatment with penicillin V four times daily might be an alternative to the currently recommended 10 day regimen.Funding Agencies|Public Health Agency of Sweden; Healthcare Committee, Region Vastra Gotaland</p

Diseño de un método transdisciplinario de evaluación predictiva y preventiva de riesgo de accidentes y trastornos musculo esqueléticos de mano por trauma acumulativo

Tesis (Doctorado en Ingeniería de Sistemas) Instituto Politécnico Nacional, SEPI; ESIME Zacatenco, 2013, 1 archivo PDF (282 páginas) tesis.ipn.m