¿Modifican nuestra actitud terapéutica los urocultivos?

Objetivo

Describir en que proporcion el resultado de los urocultivos modifica la actitud terapeutica, y factores asociados a dicho cambio.

Diseno

Descriptivo transversal mediante revision de historias.

Emplazamiento

Atencion primaria.

Sujetos

Un total de 222 urocultivos de adultos solicitados entre marzo y mayo de 1999 en 8 centros de salud.

Mediciones e intervenciones

De las historias recogimos edad, sexo, sintomas, factores de riesgo, actitud terapeutica inicial y tras recibir el urocultivo. Descartamos 358 urocultivos por no encontrar la historia clinica o no existir en esta constancia del episodio o datos acerca del cambio en la actitud terapeutica.

Resultados

Los urocultivos pertenecian a pacientes cuya edad media era de 54,2 anos, siendo un 73,1% mujer. El 34,7% no presentaba ningun factor de riesgo para ITU. Sin sintomas de ITU el 44%. Un 21,2% de urocultivos resulto positivo, siendo el germen mas aislado E. coli (69,4%). En el 44,6% se pauto tratamiento antibiotico empirico (quinolonas, 70,1%; fosfomicina, 9,3%). Tras recibir el resultado, hubo cambio de actitud en 25 casos (11,4%; EE, 2,1%), de los que 15 no recibieron tratamiento empirico (6 con sintomas, 9 sin ellos). De los 99 casos tratados empiricamente, se cambio el antibiotico en 9 (siempre por resistencias). Entre los que hubo cambio de actitud existia mayor porcentaje de factores de riesgo (84% frente a 62%, p < 0,05, χ²= 4,47); no encontramos diferencias en cuanto a edad, sexo, sintomas o germen entre ambos grupos.

Conclusiones

Existe un porcentaje nada despreciable de urocultivos que conlleva una modificacion en la actitud terapeutica, aunque la mayoria son pacientes con factores de riesgo asociados y/o que no recibieron tratamiento antibiotico empirico.

Objective

To describe to what extent the results of urocultures modify approaches to therapy and the factors linked to this change.

Design

Cross-sectional, descriptive study by means of review of records.

Setting

Primary care.

Participants

222 adult urocultures requested at 8 health centres between March and May 1999.

Interventions

.We extracted from the records age, sex, symptoms, risk factors, and approach to therapy before and after the uroculture.We discarded 358 urocultures because of not finding the clinical record or because the episode or data on the change in approach to therapy was lacking in the record.

Results

The urocultures belonged to patients with a mean age of 54.2, 73.1% of whom were women. 34.7% presented no risk factor for UTI. 44% had no symptoms of UTI. 21.2% of urocultures were positive, with E. coli the most frequently isolated bacteria (69.4%). Empirical antibiotic treatment was called for in 44.6% (70.1% quinolones, 9.3% fosfomycin). After receipt of the result, there was a change of approach in 25 cases (11.4%, SE 2.1%), of whom 15 did not receive empirical treatment (6 with symptoms and 9 without). The antibiotic was changed in 9 of the 99 cases treated empirically (always because of resistance). Among those with change of approach, there was a higher percentage of risk factors (84% against 62%, p < 0.05, χ²= 4.47). There were no differences for age, sex, symptoms or bacteria between the two groups.

Conclusions

There is a quite considerable percentage of urocultures that lead to a change in approach to therapy, although most of the patients had linked risk factors and/or did not receive empirical antibiotic treatment.