ABSTRACT
OBJECTIVE: This study aimed to assess the cause of acute pharyngitis and determine the duration of severe and moderate symptoms based on the aetiology. DESIGN: Prospective observational study. SITE: One urban health care centre. PARTICIPANTS: Patients aged 15 or older with acute pharyngitis were included. INTERVENTIONS: Bacterial identification was carried out in the microbiology lab using MALDI-TOF in two throat samples. Patients received a symptom diary to return after one week. MAIN MEASUREMENTS: Number of days with severe symptoms, scoring 5 or more in any of the symptoms included in the symptom diary, and moderate symptoms, scoring 3 or more. RESULTS: Among the 149 patients recruited, beta-haemolytic streptococcus group A (GABHS) was the most common aetiology. Symptoms and signs alone as well as the mean Centor score cannot distinguish between GABHS and other bacterial causes in patients with acute pharyngitis. However, there was a trend indicating that infections caused by Streptococcus dysgalactiae and Streptococcus agalactiae presented more severe symptoms, whereas infections attributed to the Streptococcus anginosus group, Fusobacterium spp., and those where oropharyngeal microbiota was isolated tended to have milder symptoms. S. dysgalactiae infections showed a trend towards longer severe and moderate symptom duration. CONCLUSION: GABHS was the most prevalent, but group C streptococcus caused more severe and prolonged symptoms.
ABSTRACT
Introduction. The diagnosis and management of urinary tract infections (UTI) vary widely across countries and practices. The objective of this study was to gain insight into general practitioners' (GP) perceptions on the current management of UTIs and asymptomatic bacteriuria in Spain. Methods. Cross-sectional, internet-based questionnaire study answered from July to September 2013. GPs affiliated with the largest Spanish scientific society in primary care (Sociedad Española de Medicina Familiar y Comunitaria) were invited to participate in the study. They were asked about the tests ordered in both uncomplicated and complicated UTIs and about the management in three clinical scenarios, depicting a 50-year woman with: 1. An uncomplicated UTI, 2. A complicated UTI, and 3. An asymptomatic bacteriuria. Results. The questionnaire was completed by 1,239 GPs (6.7%). Urine cultures were reportedly requested by 26.3% of the GPs in uncomplicated UTIs and by 71.8% of the cases corresponding to the complicated UTIs whereas it was declared that dipsticks were the preferred tests in only uncomplicated UTIs (38.2%). A total of 22% and 13.2% of the GPs stated that they would withhold antibiotic therapy in patients with lowcount and high-count asymptomatic bacteriuria, respectively. Conclusions. GPs have important misconceptions as to the indications for ordering urine cultures and in interpreting the definitions of common UTIs and treating UTIs and asymptomatic bacteriuria. The unnecessary use of antibiotics in patients with asymptomatic bacteriuria is considerable in Spain (AU)
Introducción. Tanto el diagnóstico como el manejo de las infecciones del tracto urinario (ITU) varían entre países y consultas. El objetivo de estudio fue conocer las percepciones de les médicos de atención primaria en cuanto al manejo de las ITU y bacteriuria asintomática en España. Métodos. Estudio transversal, basado en un cuestionario realizado online entre julio y septiembre de 2013. Se invitó a participar a los médicos de la sociedad científica más importante de atención primaria de España (Sociedad Española de Medicina Familiar y Comunitaria), a quienes se preguntó por las pruebas que solicitan en las ITU no complicada y complicada, así como el manejo en tres escenarios clínicos, que se basaban en una mujer de 50 años con 1. Una ITU no complicada, 2. Una ITU complicada y 3. Una bacteriuria asintomática. Resultados. Contestaron el cuestionario 1.239 médicos (6,7%). Los médicos declararon pedir urocultivos en un 26,3% de las ITU no complicadas y en un 71,8% de los casos de ITU complicadas mientras que admitieron usar preferentemente tiras reactivas de orina en la ITU no complicada (38,2%). Un 22% y un 13,2% de los médicos admitieron no prescribir antibióticos en casos de bacteriuria asintomática de bajo recuento y de alto recuento, respectivamente. Conclusiones. Los médicos de atención primaria tienen ideas equivocadas en cuanto a indicaciones de solicitar urocultivos, interpretar las distintas definiciones de las ITU más frecuentes y de tratar ITU y la bacteriuria asintomática. La utilización innecesaria de antibióticos en pacientes con bacteriuria asintomática es considerable en España (AU)