Abstract：
BACKGROUND: Understanding antibiotic prescribing for uncomplicated urinary tract infection (uUTI) could help to optimize management. However, data on uUTI treatment patterns in the European Union are scarce. We used real-world data to evaluate adherence to antibiotic prescribing guidelines for femalepatients with uUTI in Germany.
METHODS: This retrospective cohort study used anonymized German statutory health insurance claims data from the Wissenschaftliches Institut für Gesundheitsökonomie und Gesundheitssystemforschung from January 2013 to December 2019. Patients were female, aged ≥ 12 years, with an index uUTI diagnosis. Patient characteristics and treating physician specialties were examined overall and in sub-cohorts for recommended/non-recommended treatment (based on initial therapy adherence to German uUTI treatment guidelines) and optimal/sub-optimal outcome (based on a prescription of different antibiotics or a urinary tract infection-related episode).
RESULTS: Overall, 144,645 uUTI cases in 124,971 patients were analyzed; 51,230 (35.4%) and 93,415 (64.6%) cases were assigned to the recommended/non-recommended treatment sub-cohorts, respectively. Clinically meaningful differences in age and comorbidities were observed between these sub-cohorts. Most cases had an optimal outcome (n = 122,823; 84.9%); of these, a higher proportion received antibiotics that were recommended but not as first-choice versus first-choice therapies as their initial treatment (58.6% vs. 35.3%). In the sub-optimal outcome cohort, 49.1% received antibiotics that were recommended but not as first-choice and 41.1% received first-choice therapies as their initial treatment. Most uUTIs were treated by general practitioners (GPs; 82.3%), followed by gynecologists (13.3%), and urologists (6.8%). Notably, 64.5% of initial therapy prescriptions filled by gynecologists and 32.1% by GPs were first-choice antibiotics.
CONCLUSIONS: A high proportion of prescribed treatments for the initial uUTI episode were not recommended by German uUTI guidelines as first-choice antibiotics. Prescribing adherence varied by physician specialty; specialists showed greater adherence to treatment guidelines versus GPs. This study provides a novel and multi-dimensional picture of uUTI treatment in Germany.
Uncomplicated urinary tract infections are one of the most common infections in women. Doctors around the world use different types of antibiotics to treat people with uncomplicated urinary tract infections. We performed this study to find out more about how doctors in Germany use antibiotics to treat uncomplicated urinary tract infections. We looked at health records from female patients (aged 12+) in Germany. Overall, we examined 144,645 records. We found that around one in ten women use antibiotics to treat an uncomplicated urinary tract infection every year. We then checked to see if the doctors were giving people the right type of antibiotic, the right dose, and the right length of course. To do this, we checked against guidelines that were written by experts in Germany. We found that only one in three patients (35%) received treatment that met the guidelines. We also looked to see what differences there were between different types of doctors. For example, if general practitioners (family doctors) used different antibiotics to specialist doctors in hospitals. Four out of five patients (82%) were treated by general practitioners. We found that specialists were more likely to stick to the guidelines than general practitioners. Finally, we looked at how many patients recovered well after their first course of antibiotics. More than four out of five patients (80%) recovered well. Interestingly, more than half of the patients who had a good recovery (59%) received antibiotics that were not recommended by the guidelines.
METHODS: This retrospective cohort study used anonymized German statutory health insurance claims data from the Wissenschaftliches Institut für Gesundheitsökonomie und Gesundheitssystemforschung from January 2013 to December 2019. Patients were female, aged ≥ 12 years, with an index uUTI diagnosis. Patient characteristics and treating physician specialties were examined overall and in sub-cohorts for recommended/non-recommended treatment (based on initial therapy adherence to German uUTI treatment guidelines) and optimal/sub-optimal outcome (based on a prescription of different antibiotics or a urinary tract infection-related episode).
RESULTS: Overall, 144,645 uUTI cases in 124,971 patients were analyzed; 51,230 (35.4%) and 93,415 (64.6%) cases were assigned to the recommended/non-recommended treatment sub-cohorts, respectively. Clinically meaningful differences in age and comorbidities were observed between these sub-cohorts. Most cases had an optimal outcome (n = 122,823; 84.9%); of these, a higher proportion received antibiotics that were recommended but not as first-choice versus first-choice therapies as their initial treatment (58.6% vs. 35.3%). In the sub-optimal outcome cohort, 49.1% received antibiotics that were recommended but not as first-choice and 41.1% received first-choice therapies as their initial treatment. Most uUTIs were treated by general practitioners (GPs; 82.3%), followed by gynecologists (13.3%), and urologists (6.8%). Notably, 64.5% of initial therapy prescriptions filled by gynecologists and 32.1% by GPs were first-choice antibiotics.
CONCLUSIONS: A high proportion of prescribed treatments for the initial uUTI episode were not recommended by German uUTI guidelines as first-choice antibiotics. Prescribing adherence varied by physician specialty; specialists showed greater adherence to treatment guidelines versus GPs. This study provides a novel and multi-dimensional picture of uUTI treatment in Germany.
Uncomplicated urinary tract infections are one of the most common infections in women. Doctors around the world use different types of antibiotics to treat people with uncomplicated urinary tract infections. We performed this study to find out more about how doctors in Germany use antibiotics to treat uncomplicated urinary tract infections. We looked at health records from female patients (aged 12+) in Germany. Overall, we examined 144,645 records. We found that around one in ten women use antibiotics to treat an uncomplicated urinary tract infection every year. We then checked to see if the doctors were giving people the right type of antibiotic, the right dose, and the right length of course. To do this, we checked against guidelines that were written by experts in Germany. We found that only one in three patients (35%) received treatment that met the guidelines. We also looked to see what differences there were between different types of doctors. For example, if general practitioners (family doctors) used different antibiotics to specialist doctors in hospitals. Four out of five patients (82%) were treated by general practitioners. We found that specialists were more likely to stick to the guidelines than general practitioners. Finally, we looked at how many patients recovered well after their first course of antibiotics. More than four out of five patients (80%) recovered well. Interestingly, more than half of the patients who had a good recovery (59%) received antibiotics that were not recommended by the guidelines.
摘要：
背景：了解无并发症尿路感染（uUTI）的抗生素处方可能有助于优化管理。然而,关于欧盟uUTI治疗模式的数据很少。我们使用真实世界的数据来评估德国uUTI女性患者对抗生素处方指南的依从性。
方法：这项回顾性队列研究使用了2013年1月至2019年12月来自WissenschaftlichesInstitutfürGesundheitsökonomieundGesundheitssystemforschung的德国法定健康保险索赔数据。患者为女性,年龄≥12岁，具有索引uUTI诊断。全面检查患者特征和治疗医师专业，并在推荐/非推荐治疗（基于德国uUTI治疗指南的初始治疗依从性）和最佳/次优结果（基于不同抗生素的处方或尿路感染相关发作）的子队列中进行检查。
结果：总体而言，分析了124,971例患者中的144,645例uUTI病例；51,230例（35.4％）和93,415例（64.6％）被分配到推荐/非推荐治疗亚组，分别。在这些子队列之间观察到年龄和合并症的临床意义差异。大多数病例具有最佳结果(n=122,823;84.9%)；其中，接受推荐但不作为首选治疗的抗生素的比例更高(58.6%vs.35.3%）。在次优结果队列中，49.1%接受了推荐但不是首选的抗生素，41.1%接受了首选治疗作为初始治疗。大多数uUTI由全科医生治疗(全科医生；82.3%)，其次是妇科医生(13.3%)，和泌尿科医师(6.8%)。值得注意的是,妇科医生填写的64.5％的初始治疗处方和全科医生的32.1％是首选抗生素。
结论：德国uUTI指南不推荐高比例的初始uUTI发作处方治疗作为首选抗生素。处方依从性因医师专业而异；与全科医生相比，专家对治疗指南的依从性更高。这项研究提供了德国uUTI治疗的新颖和多维图景。
简单的尿路感染是女性最常见的感染之一。世界各地的医生使用不同类型的抗生素来治疗患有简单尿路感染的人。我们进行了这项研究，以了解更多有关德国医生如何使用抗生素治疗简单的尿路感染的信息。我们查看了德国女性患者（12岁以上）的健康记录。总的来说,我们检查了144645条记录。我们发现，每年大约有十分之一的女性使用抗生素来治疗简单的尿路感染。然后我们检查医生是否给了人们正确类型的抗生素，正确的剂量，当然还有合适的长度.要做到这一点，我们检查了德国专家撰写的指南。我们发现，只有三分之一的患者（35％）接受了符合指南的治疗。我们还观察了不同类型的医生之间的差异。例如,如果全科医生（家庭医生）在医院的专科医生使用不同的抗生素。五分之四的患者（82％）接受了全科医生的治疗。我们发现，专家比全科医生更有可能坚持指南。最后,我们观察了有多少患者在接受了第一个疗程的抗生素后恢复良好。超过五分之四的患者（80％）恢复良好。有趣的是,超过一半的恢复良好的患者(59%)接受了指南不推荐的抗生素治疗.
方法：这项回顾性队列研究使用了2013年1月至2019年12月来自WissenschaftlichesInstitutfürGesundheitsökonomieundGesundheitssystemforschung的德国法定健康保险索赔数据。患者为女性,年龄≥12岁，具有索引uUTI诊断。全面检查患者特征和治疗医师专业，并在推荐/非推荐治疗（基于德国uUTI治疗指南的初始治疗依从性）和最佳/次优结果（基于不同抗生素的处方或尿路感染相关发作）的子队列中进行检查。
结果：总体而言，分析了124,971例患者中的144,645例uUTI病例；51,230例（35.4％）和93,415例（64.6％）被分配到推荐/非推荐治疗亚组，分别。在这些子队列之间观察到年龄和合并症的临床意义差异。大多数病例具有最佳结果(n=122,823;84.9%)；其中，接受推荐但不作为首选治疗的抗生素的比例更高(58.6%vs.35.3%）。在次优结果队列中，49.1%接受了推荐但不是首选的抗生素，41.1%接受了首选治疗作为初始治疗。大多数uUTI由全科医生治疗(全科医生；82.3%)，其次是妇科医生(13.3%)，和泌尿科医师(6.8%)。值得注意的是,妇科医生填写的64.5％的初始治疗处方和全科医生的32.1％是首选抗生素。
结论：德国uUTI指南不推荐高比例的初始uUTI发作处方治疗作为首选抗生素。处方依从性因医师专业而异；与全科医生相比，专家对治疗指南的依从性更高。这项研究提供了德国uUTI治疗的新颖和多维图景。
简单的尿路感染是女性最常见的感染之一。世界各地的医生使用不同类型的抗生素来治疗患有简单尿路感染的人。我们进行了这项研究，以了解更多有关德国医生如何使用抗生素治疗简单的尿路感染的信息。我们查看了德国女性患者（12岁以上）的健康记录。总的来说,我们检查了144645条记录。我们发现，每年大约有十分之一的女性使用抗生素来治疗简单的尿路感染。然后我们检查医生是否给了人们正确类型的抗生素，正确的剂量，当然还有合适的长度.要做到这一点，我们检查了德国专家撰写的指南。我们发现，只有三分之一的患者（35％）接受了符合指南的治疗。我们还观察了不同类型的医生之间的差异。例如,如果全科医生（家庭医生）在医院的专科医生使用不同的抗生素。五分之四的患者（82％）接受了全科医生的治疗。我们发现，专家比全科医生更有可能坚持指南。最后,我们观察了有多少患者在接受了第一个疗程的抗生素后恢复良好。超过五分之四的患者（80％）恢复良好。有趣的是,超过一半的恢复良好的患者(59%)接受了指南不推荐的抗生素治疗.
