URINARY-TRACT INFECTION IN AMBULATORY PRA CTICE - DIAGNOSIS AND TREATMENT SURVEY .1. METHODOLOGY AND CLINICAL-RESULTS

Urinary tract infection and its treatment were the subject of two cons ensus lectures given on October 1989 and November 1990. It seemed inte resting to learn about medical practices for this pathology in the Rho nes-Alpes area, because of its frequency, reaching 5.3% of antibiotic prescriptions, and because of its etiological or evolutional severity in 34% of the cases. The general aim of this survey was to describe ve ry precisely how urinary infections are diagnosed and treated. Thus th e difference between practice and references found in literature could be observed, especially in relation to guidelines given during the co nsensus lectures of October 1989 and November 1990, Specific objective s were to learn about the environment of potentially severe urinary tr act infections, the relative part of severe or light urinary tract inf ections, tile sequence of complementary, tests, the usual therapy, as well as the quality of bacteriological analyses, Material was based on bacteriological analyses which were charged and reimbursed, the bill allowing to identify the insured person, the physician who prescribed this lest, the laboratory, and the prescription of the treatment. This sampling technique lead to an over-representation of the risk populat ion, and an under-representation of single dose treatments, The total number of samples was 1,235 urinary cytobacteriological analyses colle cted between May 3, 1993 and May 15, 1993, excluding those carried our in public of private hospitals, and those carried out on children, Th e physician who prescribed an urinary cytobacteriological analysis was interviewed by phone, Out of these 1,235 urinary bacteriological anal yses. 577 were identified as urinary tract infection by physicians (al though only 442 urinary bacteriological analysis reports showed the pr esence of one or more germs), In this subgroup, acute cystitis represe nted 63.8% of the cases, chronic urinary pathology 12.7%, pyelonephrit is 10.4%, asymptomatic bacteriuria 6.9%, urinary infections associated with genital infection 3.3% and prostatitis 2.9%, Clinical signs acco rding to the diagnosis, and physical signs, corresponded to etiologica l data usually described in literature, Physicians often noted pregnan cy, diabetes, and urinary catheterization, as bring potential severity factors. Age and sex were potential severity factors quoted by physic ians in respectively 37.7% and 13% of cases. Evolution was clinical re covery in 92.6% of cases and hospitalisation was necessary in less tha n 6% of cases, for all types of urinary infection. One or several epis odes followed the first urinary infection in 13.8% of cases.