Patient-initiated treatment of uncomplicated recurrent urinary tract infections in young women
Patient-initiated treatment of uncomplicated recurrent urinary tract infections in young women
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DOI：
10.7326/0003-4819-135-1-200107030-00004
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发表时间：
2001-07-03
影响因子：
39.2
通讯作者：
Stamm, WE
中科院分区：
文献类型：
--
作者：
Gupta, K;Hooton, TM;Stamm, WE
背景：反复尿路感染(UTI)是门诊常见的问题，导致频繁的办公室就诊，并经常需要使用预防性抗菌药物。目的：确定复发性尿路感染患者主动治疗的安全性和可行性。设计：非对照前瞻性临床试验。地点：以大学为基础的初级卫生保健诊所。参与者：年龄至少18岁，有复发性尿路感染病史且近期无妊娠、高血压、糖尿病或肾脏疾病的妇女。干预：根据症状自我诊断尿路感染后，参与试验的妇女开始使用氧氟沙星或左氧氟沙星进行治疗。测量：根据治疗前尿路感染确诊(培养阳性)或可能(无菌脓尿且无替代诊断)尿路感染的证据确定自我诊断的准确性。对自我诊断为尿路感染但未经微生物检查证实的女性进行评估，以寻找替代诊断。通过治疗后访谈和尿培养来评估临床和微生物治愈率、不良事件和患者满意度。结果：172名女性中有88名自我诊断出172例尿路感染。实验室检查有尿路病原体144例(84%)，无菌脓尿19例(11%)，无脓尿或菌尿9例(5%)。临床治愈和微生物治愈分别出现在92%和96%的培养确认病例中。无严重不良事件发生。结论：依从性妇女能准确地自我诊断和自我治疗反复尿路感染。
Background: Recurrent urinary tract infections (UTIs) are a common outpatient problem, resulting in frequent office visits and often requiring the use of prophylactic antimicrobial agents. Patient-initiated treatment of recurrent UTIs may decrease antimicrobial use and improve patient convenience.Objective: To determine the safety and feasibility of patient-initiated treatment of recurrent UTIs.Design: Uncontrolled, prospective clinical trial.Setting: University-based primary health care clinic.Participants: Women at least 18 years of age with a history of recurrent UTIs and no recent pregnancy, hypertension, diabetes, or renal disease.Intervention: After self-diagnosing UTI on the basis of symptoms, participating women initiated therapy with ofloxacin or levofloxacin.Measurements: Accuracy of self-diagnosis determined by evidence of a definite (culture-positive) or probable (sterile pyuria and no alternative diagnosis) UTI on pretherapy urinalysis and culture. Women with a self-diagnosis of UTI that was not microbiologically confirmed were evaluated for alternative diagnoses. Post-therapy interviews and urine cultures were used to assess clinical and microbiological cure rates, adverse events, and patient satisfaction.Results: 88 of 172 women self-diagnosed a total of 172 UTIs. Laboratory evaluation showed a uropathogen in 144 cases (84%), sterile pyuria in 19 cases (11%), and no pyuria or bacteriuria in 9 cases (5%). Clinical and microbiological cures occurred in 92% and 96%, respectively, of culture-confirmed episodes. No serious adverse events occurred.Conclusion: Adherent women can accurately self-diagnose and self-treat recurrent UTIs.