title: [Resistance testing for urinary tract infections. A barrier to guideline implementation].
abstract: BACKGROUND
  Urinary tract infections (UTI) are among the most common reasons for antibiotic prescriptions. Due to increasing resistance rates, antibiotic therapy should be targeted and based on evidence-based recommendations. Test results and recommendations by medical laboratories have a relevant impact on the choice of antibiotics. The extent to which medical laboratories consider antibiotics recommended by evidence-based treatment guidelines in microbiological testing is unclear.
  
  
  OBJECTIVE
  The aim of the present study is to assess whether guideline recommendations for antibiotic therapy of UTI are taken into account by medical laboratories in northern Germany.
  
  
  METHODS
  A standardized and piloted questionnaire was used in our telephone survey. All microbiological laboratories in northern Germany (Hamburg, Bremen, Lower Saxony, Schleswig-Holstein, and Mecklenburg-Western Pomerania; n = 82) were asked about their standards in diagnosing and microbiological testing of urine cultures.
  
  
  RESULTS
  A total of 71 of the 82 contacted laboratories perform microbiological tests, whereby 40 of these participated (56 %). Most of the laboratories (43 %) routinely perform microbiological testing when bacterial counts were ≥ 10(4) colony forming units per ml (CFU/ml), 15 % ≥ 10(5) CFU/ml, 17 % ≥ 10(3) CFU/ml, and 8 % ≥ 10(2) CFU/ml. Antibiotic testing includes ciprofloxacin (95 %), cotrimoxazole (87.5 %), trimethoprim (57 %), fosfomycin (85 %), and nitrofurantoin (72 %).
  
  
  CONCLUSIONS
  The diagnostic threshold recommended in evidence-based guidelines (10(3) CFU/ml) is used only by a few laboratories. Antibiotics recommended as a first line therapy are only partly taken into account in microbiological testing. This variance in different diagnostic thresholds and microbiological testing is a barrier to guideline implementation.
authors.affiliation: Abteilung für Versorgungsforschung, Institut für Public Health und Pflegeforschung, Universität Bremen, Grazer Straße 4, 28359, Bremen, Deutschland. schmiemann@uni-bremen.de.|Health Sciences Bremen, Universität Bremen, Bremen, Deutschland. schmiemann@uni-bremen.de.
authors.forename: G
authors.initials: G
authors.lastname: Schmiemann
authors.affiliation: Abteilung Gesundheitsökonomie, Gesundheitspolitik und Versorgungsforschung, Zentrum für Sozialpolitik, Universität Bremen, Bremen, Deutschland.
authors.forename: J
authors.initials: J
authors.lastname: Noll
authors.affiliation: Department für Versorgungsforschung, Fakultät für Medizin und Gesundheitswissenschaften, Carl von Ossietzky-Universität Oldenburg, Oldenburg, Deutschland.
authors.forename: F
authors.initials: F
authors.lastname: Hoffmann
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015373:Bacterial Typing Techniques / Q000592:standards / Q000706:statistics & numerical data; D024881:Drug Resistance, Bacterial; D005260:Female; D005858:Germany / Q000453:epidemiology; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests / Q000592:standards* / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D014552:Urinary Tract Infections / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D014572:Urology / Q000592:standards*
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotics; Diagnostics, microbiological; Drug resistance, bacterial; Health services research; Medicine, evidence-based