Community Antibiotic Use, Susceptibility and ResisTance Among Patients With Urinary Tract Infections (CAST-UTI)

St George's, University of London3,000 enrolled

Overview

1. General objective This pilot study aims to compare the prevalence of resistance in bacteria causing UTIs among patients seeking care outside the hospital settings (CDROs) to the WHO-GLASS data. 2. Specific objectives 2-1 Primary objectives: * Determine the resistance profiles of uropathogens and carriage strains from patients with uncomplicated UTIs attending community drug retail outlets (CDRO's) and in hospitals\*. * Compare the resistance profiles of the uropathogens from patients with uncomplicated UTIs attending CDROs and hospitals to those in the WHO-GLASS database. * Explore the patient pathway and its impact on antibiotic use among patients presenting to CDROs and hospitals with uncomplicated UTIs. * Determine the appropriateness of antimicrobial use in the treatment of uncomplicated UTIs among patients presenting to CDROs and hospitals 2-2 Secondary objectives: * Compare resistance profiles among the uropathogens from patients from two neighbourhoods in Kampala. * Examine environmental samples between the study sites to determine the presence of antibiotic residues and AMR two neighbourhoods in Kampala.

Study Type

OBSERVATIONAL

Enrollment

3,000

Conditions

Urinary Tract Infections (UTIs)

Eligibility

Sex: ALL

Medical Language ↔ Plain English

Inclusion criteria: * Must have one or more of the following clinical presentations regardless of age: acute (\< 2 weeks) dysuria. increased urinary urgency and frequency, irritation, discharge. increased lower abdominal pain or discomfort and sometimes gross haematuria. * In elderly patients with pre-existing urinary symptoms: increased acute urinary changes. Exclusion criteria: * People without symptoms of UTI.

Outcomes

Primary Outcomes

A comparison of resistance profiles between GLASS and community uropathogens in Uganda

Twelve-month prevalence of antimicrobial resistance in Escherichia coli and Klebsiella pneumoniae isolates causing urinary tract infections, comparing GLASS surveillance data and data collected in the community in Uganda. Resistance will be measured as the proportion of isolates non-susceptible to key antibiotic classes (e.g., third-generation cephalosporins, fluoroquinolones, carbapenems).

Time frame: At the end of 12 months data collection

Secondary Outcomes

Patient pathway and antibiotic use in the community

Characterisation of the patient pathway from symptom onset to days 7 and 28 in individuals with urinary tract infections, and its association with antibiotic use patterns (e.g., timing, type, source, appropriateness). Collect information on healthcare seeking behaviour for eligible patients, including their sociodemographic information, antibiotics purchased, and cost of antibiotics.

Time frame: 28 days

Appropriateness of antimicrobial use in the treatment

Proportion of UTI cases in the community with microbiologically confirmed E. coli or K. pneumoniae where the prescribed or obtained antibiotic treatment was appropriate, based on standard treatment guidelines and the organism's resistance profile.

Time frame: 7 days after enrolment

Retail outlet determinants of treating healthcare-seeking among patients with suspected UTIs

The investigators are collecting information on the number of UTIs presenting at community drug retail outlets over twelve months, antibiotic availability in the ommunity drug retail outlet, compliance with regulations, and healthcare worker training level.

Time frame: At the end of 12 months after enrolment

Antibiotic residues and AMR in two neighbourhoods in Kampala

Detection of antibiotic residues and antimicrobial resistant organisms in environmental water samples from channels linking the two study neighbourhoods. Through detection of antibiotic residues and testing of microorganisms isolated from the waterway and sediment.

Time frame: Once a month for 12 months after study commencement