Culture informed management of urinary tract infections in primary care: a qualitative study of impact and value

Diagnostics are increasingly touted as a tool to combat antimicrobial resistance. However, relatively little is known about how microbiology results are utilised in practice and the impact on antimicrobial stewardship. This is true for urinary tract infections (UTIs) where culture is the gold standard diagnostic test despite well-recognised imperfections in accuracy. Given the burden of UTIs in primary care, the aim of this study was to understand how primary care practitioners (PCPs) interpret and respond to culture results. Thirteen participants undertook semi-structured interviews exploring the requesting of tests, processing of results and attitudes to diagnostics in UTI. Participants were posed with five hypothetical clinical scenarios to explore analysis and interpretation of urine culture results. Anonymised transcripts were coded and thematic analysis utilised. Participants were familiar with testing strategies and felt confident interpreting results although areas of less certainty were identified. Amongst hypothetical scenarios posed, considerable variation was observed resulting in heterogenous onward prescribing decisions. Participants felt that culture results altered patient management in approximately 10–20% of cases but identified other less tangible benefits of testing such as prescriber reassurance. Prolonged laboratory turn-around times was frequently cited as the reason antibiotics were not amended or stopped when results became available supporting that improved diagnostic methods are required. This study confirmed urine culture does have value to PCPs, but the impact on patient management was perceived to be small. Further research is needed to evaluate the relationship between patients, prescribing and laboratory results at scale.