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| 2. |
- Isberg, Helena Kornfält, et al.
(författare)
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Increased adherence to treatment guidelines in patients with urinary tract infection in primary care : A retrospective study
- 2019
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Ingår i: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 14:3
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Tidskriftsartikel (refereegranskat)abstract
- Background Urinary tract infection (UTI) is common in primary care and leads to a high number of antibiotic prescriptions. Antimicrobial resistance is a global health problem; better antimicrobial prescribing is one way to limit antimicrobial resistance. We aimed to describe the number of consultations for patients diagnosed with lower urinary tract infection (LUTI) and pyelonephritis and changes in prescribing of antibiotics to men and women with LUTI and pyelonephritis in Swedish PHC between the years 2008 and 2013. Methods We performed a descriptive study of changes in UTI diagnosis and antibiotic prescribing in UTI for the years 2008, 2010 and 2013. The Primary Care Record of Infections in Sweden, a database regarding diagnosis linked antibiotic prescribing in primary care, was analyzed concerning data for men and women of all ages regarding UTI visits and antibiotic prescribing. The results were analyzed in relation to current national guidelines. Results There was a variability in consultation incidence for LUTI with an increase between 2008 and 2010 and a decrease between 2010 and 2013, resulting in a slight rise in consultation incidence between 2008 and 2013. The use of recommended nitrofurantoin or pivmecillinam in LUTI in women increased from 54% in 2008 to 69% in 2013. Fluoroquinolones or trimethoprim were prescribed in 24% of LUTI cases in women in 2008 and in 7% of cases in 2013. Prescriptions of pivmecillinam or nitrofurantoin in male LUTI cases increased from 13% in 2008 to 31% in 2013. Fluoroquinolones or trimethoprim were prescribed in 54% of male LUTI cases in 2008 and 32% in 2013. Conclusions Swedish GPs seem to follow national guidelines in the treatment of LUTI in women. In male LUTI cases, the prescriptions of fluoroquinolones remain high and further research is needed to follow prescription patterns and enhance more prudent prescribing to this group of patients.
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| 3. |
- Jensen, Jette Nygaard, et al.
(författare)
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Comparison of antibiotic prescribing and antimicrobial resistance in urinary tract infections at the municipal level among women in two Nordic regions
- 2018
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Ingår i: Journal of Antimicrobial Chemotherapy. - : Oxford University Press (OUP). - 0305-7453 .- 1460-2091. ; 73:8, s. 2207-2214
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To describe and compare the prescribing of antibiotics used for urinary tract infections and its correlation with resistance in Escherichia coli in urinary samples across two adjacent regions - the Capital Region and the Skaane Region - and their municipalities in Denmark and Sweden. Methods: The Capital Region consists of 29 municipalities and 725 960 female inhabitants aged ≥18 years and the Skaane Region consists of 33 municipalities and 515 668 female inhabitants aged ≥18 years. Aggregated data from outpatient care on the prescribing of pivmecillinam, trimethoprim and nitrofurantoin from both regions were analysed. The Department of Clinical Microbiology in both regions provided data on E. coli resistance in urinary samples from women aged ≥18 years. Data were measured as the number of prescriptions/1000 women/year, number of DDDs/1000 women/year and DDDs/prescription. Correlation analyses between antibiotic prescribing and antibiotic resistance rates were performed. Results: Antibiotic prescribing and resistance rates were significantly higher in the Capital Region compared with the Skaane Region. Large variations in prescription and resistance rates were found at the municipal level, but there were no correlations between the antibiotic prescription and resistance rates when each region was analysed separately. Conclusions: Although closely related, there are large differences in antibiotic prescribing and antibiotic resistance. It is suggested that the regional guidelines are an important driver and explanatory factor for the variations; however, further research is needed in this new field and factors such as the influence of cultural aspects should be the target of further research.
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| 4. |
- Kornfält Isberg, Helena, et al.
(författare)
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Different antibiotic regimes in men diagnosed with lower urinary tract infection - a retrospective register-based study
- 2020
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 38:3, s. 291-299
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Tidskriftsartikel (refereegranskat)abstract
- Objective To compare the proportion of therapy failure, recurrence and complications within 30 days after consultation between men diagnosed with lower urinary tract infection (UTI) treated with narrow-spectrum antibiotics (nitrofurantoin or pivmecillinam) and broad-spectrum antibiotics (fluoroquinolones or trimethoprim or trimethoprim/sulfamethoxazole). Design A retrospective cohort study based on data derived from electronic medical records between January 2012 and December 2015. Setting Primary health care and hospital care in five different counties in Sweden. Patients:A total of 16,555 men aged between 18 and 79 years diagnosed with lower UTI. Main outcome measures Treatment with narrow-spectrum antibiotics was compared with broad-spectrum antibiotics regarding therapy failure, recurrence and complications within 30 days. Results The median age of included men was 65 IQR (51-72) years. Narrow-spectrum antibiotics were prescribed in 8457 (40%) and broad-spectrum antibiotics in 12,667 (60%) cases, respectively. Therapy failure was registered in 192 (0.9%), recurrence in 1277 (6%) and complications in 121 (0.6%) cases. Therapy failure and recurrence were more common in patients treated with narrow-spectrum antibiotics and trimethoprim (p < 0.001), but no such difference could be detected regarding complications. Conclusion There was no difference in incidence of complications within 30 days between men treated with narrow- or broad-spectrum antibiotics. Patients prescribed broad-spectrum antibiotics had lower odds of reconsultation because of therapy failure and recurrence. From current data, treatment with narrow-spectrum antibiotics seems to be an optimal choice regarding preventing complications when treating men with lower UTI.
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| 5. |
- Kornfält Isberg, Helena, et al.
(författare)
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Uncomplicated urinary tract infection in primary health care : presentation and clinical outcome
- 2021
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Ingår i: Infectious Diseases. - : Informa UK Limited. - 2374-4235 .- 2374-4243. ; 53:2, s. 94-101
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Tidskriftsartikel (refereegranskat)abstract
- Background: Uncomplicated urinary tract infection (UTI) causes bothersome symptoms among women and is a leading cause for antibiotic prescribing in primary healthcare (PHC). Methods: A prospective observational study in eight different PHC centres in Sweden including 192 women with symptoms of uncomplicated UTI. Questionnaires and symptom diaries were used to retrieve patient data. All urine samples were analysed with urine culture and susceptibility testing. The aim was to describe the clinical presentation of symptoms in uncomplicated UTI in relation to bacterial findings in urine and to describe the course and duration of symptoms in relation to anamnestic factors, bacterial findings and antibiotic treatment. Results: Median symptom duration before seeking care was four days (IQR 1–7). Restrictions in daily life related to symptoms of uncomplicated UTI were reported by the majority (74%) of respondents. The median number of days concerning any symptom after consultation was 4.0 days (IQR 2.0–5.0) for patients treated with antibiotics, and 6.5 days (IQR 3.0–10.0) for patients not treated with antibiotics. There was an association between longer symptom duration after consultation and age over 50 years, relative risk (RR) 1.76 (95% CI 1.25–2.49). Antibiotic treatment RR 0.47 (95% CI 0.27–0.81) was associated with reported shorter duration of symptoms. Conclusions: Women visiting primary health care with symptoms indicating uncomplicated UTI have symptoms for several days before seeking care and after consulting. A majority of patients feel restricted in their daily activities due to uncomplicated UTI. Older women and women not treated with antibiotics have the longest symptom duration after consultation.
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| 6. |
- Kornfält Isberg, Helena, et al.
(författare)
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Uncomplicated urinary tract infections in Swedish primary care; Etiology, resistance and treatment
- 2019
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Ingår i: BMC Infectious Diseases. - : Springer Science and Business Media LLC. - 1471-2334. ; 19:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Uncomplicated urinary tract infection (uUTI) is common and a majority of patients are prescribed antibiotics. There is little knowledge about antibiotic resistance in urine samples from patients with uUTI in primary health care (PHC). The aim was to describe antibiotic treatment, bacterial findings, the prevalence of resistant E.coli and factors associated with antibiotic resistance. The aim was also to compare the prevalence of resistant E.coli in clinical practice with the prevalence of resistant E.coli in routine microbiological laboratory data. Methods: This observational study in PHC setting started in November 2014 and ended in March 2016. Women aged 17 years and older with symptoms indicating uUTI from eight PHCs were included. Questionnaires were used to retrieve anamnestic data. All urine samples were sent to the local laboratory of microbiology for diagnostic analysis and susceptibility testing. Proportions of resistant E.coli were compared with corresponding data from the regional laboratory. Results: Urine cultures were analysed in 304 women with a median age of 46 (IQR 32-66) years. Bacterial growth was found in 243 (80%) of urine samples, and E.coli in 72% of the positive samples. A total of 80% of detected E.coli isolates were susceptible to all tested antimicrobials and resistance rates to ciprofloxacin were lower than reported from the local clinical laboratory. Antibiotic treatment within the last year was independently associated with antibiotic resistant E.coli in the urine sample adjusted OR 4.97 (95% CI 2.04-12.06). A total of 74% of the women were treated with antibiotics. The most prescribed was pivmecillinam followed by nitrofurantoin. Conclusions: Antibiotic resistance in E.coli was low. Antibiotic treatment within the last year was associated with antibiotic resistant E.coli. Data from the clinical microbiology laboratory indicates that laboratory data may overestimate antibiotic resistance and lead to an unnecessary change in empiric antibiotic treatment of uUTI in primary care. The empirically prescribed antibiotics, were inline with Swedish treatment recommendations for uUTI.
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| 8. |
- Kornfält Isberg, Helena
(författare)
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UVI hos kvinnor – akut cystit
- 2017
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Ingår i: Läkemedelsbehandling av urinvägsinfektioner i öppenvård – bakgrundsdokumentation. ; , s. 14-16
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Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- Hos friska kvinnor är akut cystit besvärande men ofarligt. Infektionen läker spontant, behandling förkortar tiden med symtom och ges i symtomlindrande syfte. Akut cystit är en bakteriell infektion i urinblåsans slemhinna och definieras som nytillkommen sveda, trängningar och ökad frekvens till vattenkastning samtidigt med bakterier i urinen. Diagnostiken i primärvården baseras framför allt på kliniska symtom, resultatet av urinsticka och urinodling. Positiv urinodling är referensmetod. Resultatet av diagnostiska tester är ofta svårtolkat ochflera studier har gjorts med målsättning att förbättra diagnostiken genom kliniska algoritmer. Studierna är svåra att jämföra, bland annat eftersom olika referens-metoder använts vid urinodling, svårighetsgraden av registrerade kliniska symtom oftast inte är bedömd och de flesta studierna inte har validerat den diagnostiska modellen. Studierna bekräftar osäkerheten i att ställa diagnosen akut cystit enbart utifrån kliniska symtom. Urinsticka kan i vissa fall vara ett stöd i diagnostiken. De i Sverige rekommenderade förstahandspreparaten vid behandling har visat sig ha en god klinisk effekt vid akut cystit. Trimetoprim bör endast användas efter urinodling på grund av hög förekomst av resistens bland Escherichia coli. Placebobehandling eller behand-ling med ibuprofen har ingen påvisad effekt men fort-satta studier pågår. Det finns ingen evidens för effekten av tranbärsprodukter vid behandling av akut cystit.
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| 9. |
- Siddiqui, Faiza, et al.
(författare)
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The Effect of Family History of Diabetes and Middle Eastern Background on Abdominal Obesity is Modified by Gender: A Population based Cross-Sectional Study
- 2018
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Ingår i: Current Research in Diabetes & Obesity Journal (CRDOJ). - 2476-1435. ; 6:1, s. 1-9
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Tidskriftsartikel (refereegranskat)abstract
- Background: Abdominal obesity is on the increase worldwide and ethnic minority groups are at high risk. However, studies of the underlying causes are scarce. The aims of this study were to investigate the prevalence of abdominal obesity and to identify metabolic, lifestyle and socio-demographic risk factors associated with abdominal obesity in male and female residents of Malmö, a city in southern Sweden, comparing those born in Iraq with those born in Sweden.Method: We conducted a population-based, cross-sectional study from 2010 to 2012. Both male and female residents of Malmö, aged 30-75 years, born in Iraq (n=1387) or Sweden (n=749), underwent a physical examination. Fasting blood samples were drawn and socio-demography and lifestyle were characterized using questionnaires. Associations with abdominal obesity were assessed by logistic regression analysis.Results: Abdominal obesity (waist circumference ≥80 cm in women and ≥94 cm in men) was highly prevalent and was most common in Iraqi-born women (Iraqi-born women 89.2% vs. Swedish women 73.1%, p<0.001, Iraqi-born men 70.2% vs. Swedish men 63.6%, p<0.003). Furthermore, family history of diabetes was more prevalent in participants born in Iraq than those born in Sweden (53.6% vs.28.5%, p<0.001). Based on the total study population, female gender, Middle Eastern background, family history of diabetes and depression conveyed higher odds of abdominal obesity. Family history of diabetes and Middle Eastern origin conveyed higher odds of abdominal obesity in females than in males (Pinteraction: Female gender*Family history=0.023; Pinteraction: Female gender*Middle Eastern origin =0.011).Conclusion: Abdominal obesity is highly prevalent irrespective of Middle Eastern or Caucasian background but most prevalent in Iraqi-born women. Our findings suggest that factors related to heritage such as genetics and traditional lifestyles, influence excess risk in Middle Eastern females in particular, which should be taken into consideration when planning preventive actions.Keywords: Abdominal obesity; Migration; Middle East; Family history of diabetes; GenderAbbreviations: BMI: Body Mass Index; CVD: Cardiovascular Disease; FPG: Fasting Plasma Glucose; HAD scale: Hospital Anxiety and Depression Scale; IDF: International Diabetes Federation; OGTT: Oral Glucose Tolerance Test; PA: Physical Activity; The MEDIM study: The Impact of Migration and Ethnicity on Diabetes in Malmö; T2D: Type 2 Diabetes; WHO: World Health Organization
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