CROCUS
Research type
Research Study
Full title
Circumstances and variables associated with UTI-derived E.coli bacteraemia in patients; a cohort and survey study.(CROCUS study: Case Review Of Community Urinary tract infection Study)
IRAS ID
282035
Contact name
Stacey Fisher
Contact email
Sponsor organisation
North Cumbria Integrated Care NHS Foundation Trust
Clinicaltrials.gov Identifier
CROCUS, CROCUS
Duration of Study in the UK
0 years, 7 months, 27 days
Research summary
Summary of Research
Urinary tract infections (UTI) are the most common bacterial infection treated in primary care, and is usually caused by the bacterium E.coli. There is a risk of the infection leading to blood poisoning – known as bacteraemia – and this can have fatal consequences. There are some known risk factors associated with developing bacteraemia, including patient age, use of a catheter and a long hospital stay. However, less is known about whether other variables such as patient behaviour or UTI management by the GP can be linked with a higher risk of developing the bacteraemia complications. In this study, patients with a recent UTI are asked about how they managed the condition and what their opinion is around seeking help from their GP practice. We also analyse the GP notes to see if patients are managed in accordance with national guidance. By comparing information from patients who did and did not develop UTI E.coli bacteraemia, factors may be identified that are linked to the risk of developing complications. If clues are found that may associate certain elements with increased risk of UTI E.coli bacteraemia, these may be tackled in the future to reduce the incidence of this potentially life-threatening condition. Covering the patient journey for a UTI episode may unearth trends or patterns that would not be spotted if only a single element (eg the GP consultation) was to be reviewed.Summary of Results
Lay summary of study results: Urinary tract infection (UTI) is a common ailment that can develop into sepsis. The outcomes related to UTI may potentially be affected by both patient and clinician management of UTI. The objective of this study was to explore the circumstances around a single UTI episode, to determine if there are any patient and clinician related variables that may contribute to differences in management. The study design was a aurvey and audit cohort that involved patients from 12 General Practices in England; 504 completed patient surveys and corresponding index UTI consultation audits were analysed. The TARGET (Treat Antibiotics Responsibly, Guidance, Education and Tools) UTI audit toolkit was utilised. Our main findings were that males self-manage their UTI symptoms less often – e.g. increased fluid intake (P < 0.001) and analgesics use (P 0.036) – and indicate they lack UTI knowledge (P 0.020) when compared to females (Chi-squared tests). Antibiotics were prescribed in over 97% of all cases, with adherence to clinical diagnostic guidelines lowest in females <65 years; based on medical records evidence, only 41% (89/221 cases) could be diagnosed as a UTI using the TARGET criteria. Our conclusions are that UTI symptom management by clinicians is sub-optimal; (the lack of) symptoms are often insufficiently recorded in medical records. Furthermore, a failure to adhere to the guidelines concerning (dipstick) urinalysis and microbiological investigation is common. The known increased clinical risks for males may be compounded by their more limited knowledge of (self)-managing UTI and comparatively late presentation.REC name
South Central - Berkshire Research Ethics Committee
REC reference
21/SC/0205
Date of REC Opinion
9 Jun 2021
REC opinion
Favourable Opinion