Improved management of cystitis in primary care following the implementation of a simple multifaceted intervention

SWOT and Root Cause Analyses of Antimicrobial Resistance to Oral Antimicrobial Treatment of Cystitis

“…A systematic review of AMS in long-term care facilities in France found that the volume of antibiotic prescriptions was positively associated with staff turnover and after-hours medical practitioner visits, which could be corrected by an on-site coordinating physician [151]. Likewise, a multifaceted intervention for AMS in different parts of the world resulted in either reduction of treatment duration [152,153] or in better informed choice of OAT [137,138].…”

“…Furthermore, cystitis can dilate the tight junctions of the inflamed urothelium [12,65,82] to reportedly cause a four-fold rise in creatinine reabsorption [55,67] via passive paracellular diffusion, and the resulting decline in the urine creatinine levels can potentially introduce errors in the estimation of the renal function status of cystitis patients, leading to their under-and overdosing of OAT [25,113]. Given that every dose of an OAT regimen produces an initial subtherapeutic concentration in urine [122] during the intended build-up to the MIC, which is itself indeterminable, there is an inevitable period of potential AMR risk with the initiation of OAT, even with AMS [40,41,[137][138][139]. Thus, our root cause analysis (studies listed in Table 1) identifies the initial delay in the MIC as the root cause of AMR, which is a risk with every treatment course of OAT for cystitis.…”