title: When do general practitioners request urine specimens for microbiology analysis? The applicability of antibiotic resistance surveillance based on routinely collected data.
abstract: OBJECTIVE
  We do not know how representative reported levels of resistance to antibiotics in urinary tract infections (UTIs) are as there is wide variation in the rate of urine specimens submitted to microbiology laboratories by general practices. We used a questionnaire to investigate variation in sampling for patients with suspected UTI to explore any systematic bias that may influence interpretation of surveillance data based on routine data.
  
  
  METHODS
  We sent a questionnaire to a stratified random sample of general practitioners (GPs) in Wales for self-completion. The GPs were presented with six clinical scenarios and asked about their proposed clinical management.
  
  
  RESULTS
  We found that nearly all of the GPs indicated they would request a specimen for scenarios representing a probable UTI in a female child and a probable asymptomatic UTI in pregnancy. There was some variation between the GPs about sampling in a situation of treatment failure in an older woman and recurrent UTI in a male diabetic, with 90% and 81%, respectively, indicating they would request a specimen for these scenarios. The greatest variation was in relation to scenarios concerning the management of a probable uncomplicated UTI, and early patient symptoms with pressure to prescribe, with 56% and 33% of GPs, respectively, indicating they would request a urine specimen for laboratory analysis.
  
  
  CONCLUSIONS
  In the light of this reported sampling behaviour, it is likely that there is a systematic bias in surveillance data based on routinely collected data, with samples from cases of uncomplicated UTI being under represented, potentially leading to an overestimation of true resistance rates.
authors.affiliation: Department of Epidemiology, Statistics and Public Health, Centre for Health Sciences Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4XN, UK. sharon.hillier@nphs.wales.nhs.uk
authors.forename: Sharon
authors.initials: S
authors.lastname: Hillier
authors.forename: Joanna
authors.initials: J
authors.lastname: Bell
authors.forename: Margaret
authors.initials: M
authors.lastname: Heginbothom
authors.forename: Zoë
authors.initials: Z
authors.lastname: Roberts
authors.forename: Frank
authors.initials: F
authors.lastname: Dunstan
authors.forename: Anthony
authors.initials: A
authors.lastname: Howard
authors.forename: Brendan
authors.initials: B
authors.lastname: Mason
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Butler
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019468:Disease Management; D004351:Drug Resistance; D005194:Family Practice / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D011795:Surveys and Questionnaires; D014552:Urinary Tract Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology*; D014556:Urine / Q000382:microbiology*; D014852:Wales
chemical_list: D000900:Anti-Bacterial Agents