title: Antimicrobial resistance surveillance in urinary tract infections in primary care.
abstract: Urinary tract infection (UTI) is one of the most common reasons for prescription of antimicrobials in primary care. Laboratory resistance data produced because of specimen analysis to support individual patient diagnosis and management are generalized to guide empirical therapy across a wider population, but are limited by bias toward certain patient groups and almost certainly overestimate the incidence of resistance. Other methods of surveillance are required to provide unbiased estimates of antimicrobial resistance, but need to be sustainable. Sentinel surveillance, perineal flora sampling and development of clinical algorithms to support more stratified and personalized antimicrobial prescribing need to be further investigated. Linkages to prescription and clinical outcome data are essential if the burden of antimicrobial resistance in UTI is to be understood. Pilot and feasibility studies need to be performed to establish the best approach to enhancing the quality, relevance and sustainability of antimicrobial resistance surveillance in community-acquired UTI.
authors.affiliation: Public Health England National Infection Service-Specialist Microbiology Services-South West, Department of Infection Sciences, Westbury-on-Trym, Bristol BS10 5NB, UK tehli.chin@nbt.nhs.uk.
authors.forename: Teh Li
authors.initials: TL
authors.lastname: Chin
authors.affiliation: Public Health England National Infection Service-Primary Care Unit, Microbiology Laboratory, Gloucestershire Royal Hospital, Great Western Road, Gloucester GL1 3NN, UK.
authors.forename: Cliodna
authors.initials: C
authors.lastname: McNulty
authors.affiliation: Public Health England National Infection Service-Field Epidemiology Services-South West, 2 Rivergate, Temple Quay, Bristol BS1 6EH, UK.
authors.forename: Charles
authors.initials: C
authors.lastname: Beck
authors.affiliation: Public Health England National Infection Service-Specialist Microbiology Services-South West, Department of Infection Sciences, Westbury-on-Trym, Bristol BS10 5NB, UK.
authors.forename: Alasdair
authors.initials: A
authors.lastname: MacGowan
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D000066491:Clinical Decision-Making; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000382:microbiology; D011307:Drug Prescriptions; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006801:Humans; D011320:Primary Health Care; D018571:Sentinel Surveillance; D014552:Urinary Tract Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents