Advertisement

Managing ESBL-producing Enterobacteriaceae-related urinary tract infection in primary care: a tool kit for general practitioners

  • Aurélie Zucconi
  • Johan Courjon
  • Christophe Maruéjouls
  • Fabrice Saintpère
  • Nicolas Degand
  • Lilli Pandiani
  • Christian Pradier
  • Véronique Mondain
Original Article

Abstract

In Southern France, approximately 4% of E. coli isolates from community-acquired urinary tract infections are extended spectrum beta-lactamase producers, while carriage rates for enterobacteriaceae (ESBL-E) range from 3 to 6%. General practitioners (GP) are unfamiliar with the management of patients harboring ESBL-E. Providing them with a specific tool kit should assist in their therapeutic approach and optimize antimicrobial prescription an ESBL-E tool kit was developed by a multidisciplinary team: infectious diseases (ID) specialists, microbiologists, pharmacologists, and nursing home staff. This tool kit includes treatment protocols, GP and patient information leaflets, a list of infection control measures, and contact details of ID physicians for specialized advice. A community-based (including nursing homes) prospective study was conducted in 2012 in Southeastern France to test the tool kit in the context of ESBL-E-related urinary tract infections (UTI). ESBL-E-related UTI were identified in 88 patients, 66 GPs were contacted by the microbiology laboratory, 56 stated they were offered the tool kit, 48 said they had received it, and 41 stated they had read its contents. Use of the tool kit was significantly correlated with appropriate antibiotic prescription, which concerned 36/39 tool kit users versus 13/20 non-users (p = 0.0125) and 40 GPs expressed an average satisfaction rate of 4.2 on a scale of 0 to 5. Availability of a specific tool for managing patients harboring ESBL-E, now completed with a website, can assist community-based GPs and improve antimicrobial prescription.

Notes

Acknowledgements

Our thanks to Brigitte Dunais for her assistance in the preparation of this manuscript.

Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflicts of interest.

Ethical approval

For this type of study, ethical approval was not required.

Informed consent

Informed consent was not required for this study.

References

  1. 1.
    Rossotti R, Orani A (2012) Clinical management of ESBL-producing Enterobacteriaceae: the insidious role of fluoroquinolones. Eur J Clin Microbiol Infect Dis 31(7):1517–1522.  https://doi.org/10.1007/s10096-011-1472-y CrossRefPubMedGoogle Scholar
  2. 2.
    De Rosa FG, Pagani N, Fossati L, Raviolo S, Cometto C, Cavallerio P, Parlato C, Guglielmi E, Serra R, Di Perri G (2011) The effect of inappropriate therapy on bacteremia by ESBL-producing bacteria. Infection 39(6):555–561.  https://doi.org/10.1007/s15010-011-0201-x CrossRefPubMedGoogle Scholar
  3. 3.
    Cantón R, Novais A, Valverde A, Machado E, Peixe L, Baquero F, Coque TM (2008) Prevalence and spread of extended-spectrum beta-lactamase-producing Enterobacteriaceae in Europe. Clin Microbiol Infect 14(Suppl 1):144–153CrossRefPubMedGoogle Scholar
  4. 4.
    Trépos JY, Laure P (2008) General practioners and medical guidelines: a sociological approach. [article in French]. Rev Epidemiol Sante Publique 56(Suppl 3):S221–S229.  https://doi.org/10.1016/j.respe.2008.04.007 CrossRefPubMedGoogle Scholar
  5. 5.
    Giry M, Pulcini C, Rabaud C, Boivin JM, Mauffrey V, Birgé J (2016) Acceptability of antibiotic stewardship measures in primary care. Med Mal Infect 46(6):276–284.  https://doi.org/10.1016/j.medmal.2016.02.001 CrossRefPubMedGoogle Scholar
  6. 6.
    Bourdellon L, Thilly N, Fougnot S, Pulcini C, Henard S (2017) Impact of selective reporting of antibiotic susceptibility test results on the appropriateness of antibiotics chosen by French general practitioners in urinary tract infections: a randomised controlled case-vignette study. Int J Antimicrob Agents 50(2):258–262.  https://doi.org/10.1016/j.ijantimicag.2017.01.040 CrossRefPubMedGoogle Scholar
  7. 7.
    Chervet D, Lortholary O, Zahar JR, Dufougeray A, Pilmis B, Partouche H (2017) Antimicrobial resistance in community-acquired urinary tract infections in Paris in 2015. Med Mal Infect.  https://doi.org/10.1016/j.medmal.2017.09.013
  8. 8.
    Jaffe A, Yoselis A, Tripto-Shkolnik L (2015) Better together: a community-hospital integrative model of healthcare as a practical solution for providing excellence in endocrinology care in an era of limited resources. Isr J Health Policy Res 4:28.  https://doi.org/10.1186/s13584-015-0024-9. eCollection 2015.
  9. 9.
    Björkman I, Berg J, Viberg N, Stålsby Lundborg C (2013) Awareness of antibiotic resistance and antibiotic prescribing in UTI treatment: a qualitative study among primary care physicians in Sweden. Scand J Prim Health Care 31(1):50–55.  https://doi.org/10.3109/02813432.2012.751695 CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Centre Hospitalo-Universitaire de NiceNiceFrance

Personalised recommendations