title: Point of care susceptibility testing in primary care - does it lead to a more appropriate prescription of antibiotics in patients with uncomplicated urinary tract infections? Protocol for a randomized controlled trial.
abstract: BACKGROUND
  Urinary tract infection (UTI) is a common infection in primary care and is the second leading reason for prescription of antibiotics in Denmark. The diagnosis is often based on symptoms and urine dip-stick, which has limited validity, causing the risk of unnecessary antibiotic prescription. Additionally, with increasing antibiotic resistance, the risk of choosing an antibiotic to which an infecting pathogen is resistant is rising. Combined point-of-care-tests (POCT) for urine culture and susceptibility testing have been developed and validated for primary care, and performing such a test in all patients with suspected UTI in primary care seems rational in order to reduce the use of inappropriate antibiotics. However, the clinical effect of the culture and susceptibility test has not yet been investigated. This study aims to investigate whether POCT urine culture and susceptibility testing decreases the inappropriate use of antibiotics and leads to faster patient recovery.
  
  
  METHODS
  Randomized controlled open label trial of two diagnostic approaches. 750 patients with symptoms of uncomplicated UTI, consecutively contacting their general practitioner (GP), randomized to either POCT urine culture and susceptibility testing and targeted treatment or POCT urine culture without susceptibility testing and empirical treatment. Treatment is started when the POCT is read. The two groups are compared with regard to appropriate choice of antibiotics, clinical remission, and microbiological cure rates.
  
  
  CONCLUSIONS
  The results of this study may provide important evidence to recommend POCT culture and susceptibility testing in all patients with suspected uncomplicated UTI. This could become an additional strategy to fight antibiotic resistance.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT02323087 .
authors: Department of Public Health, The Research Unit for General Practice and Section of General Practice, University of Copenhagen, Øster Farimagsgade 5 opg. Q, PO box 2099, 1014, Copenhagen K, Denmark. anneholm@sund.ku.dk.
authors: Anne
authors: A
authors: Holm
authors: Department of Public Health, The Research Unit for General Practice and Section of General Practice, University of Copenhagen, Øster Farimagsgade 5 opg. Q, PO box 2099, 1014, Copenhagen K, Denmark. gloriac@sund.ku.dk.
authors: Gloria
authors: G
authors: Cordoba
authors: Department of Veterinary Clinical and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Dyrlægevej 16, 1870, Frederiksberg C, Denmark. tims@sund.ku.dk.
authors: Tina Møller
authors: TM
authors: Sørensen
authors: Department of Veterinary Clinical and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Dyrlægevej 16, 1870, Frederiksberg C, Denmark. lrmj@sund.ku.dk.
authors: Lisbeth Rem
authors: LR
authors: Jessen
authors: Department of Public Health, The Research Unit for General Practice and Section of General Practice, University of Copenhagen, Øster Farimagsgade 5 opg. Q, PO box 2099, 1014, Copenhagen K, Denmark. siersma@sund.ku.dk.
authors: Volkert
authors: V
authors: Siersma
authors: Department of Public Health, The Research Unit for General Practice and Section of General Practice, University of Copenhagen, Øster Farimagsgade 5 opg. Q, PO box 2099, 1014, Copenhagen K, Denmark. lbjerrum@sund.ku.dk.
authors: Lars
authors: L
authors: Bjerrum
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002985:Clinical Protocols; D003718:Denmark; D024881:Drug Resistance, Bacterial; D006801:Humans; D008826:Microbial Sensitivity Tests / Q000379:methods; D000067716:Point-of-Care Testing; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents