‘There is no choice apart from antibiotics…’: Qualitative analysis of views on urinary infections in pregnancy and antimicrobial resistance

Abstract

Background: Antimicrobial resistance (AMR) is a health risk as it can lead to lifethreatening infections. There has been a rise in resistant urinary tract infections (UTIs) which is the most common infection in pregnancy. This can be challenging in pregnancy due to the additional need to safeguard foetal development. The study's aim was to explore views about AMR in women who experienced UTIs in pregnancy. Design: Fifteen semi-structured interviews were conducted in the UK and analysed using thematic analysis. Results: Results highlighted two themes: conceptualization of AMR and pregnancy as a deviation from the norm, with an overarching theme of 'self-efficacy'. Results show that participants were concerned about AMR but uncertain about the effect on society compared to individual's taking antibiotics and about completing antibiotic courses. Participants reported an unsparing use of antibiotics was justified in pregnancy, and behaviours like drinking adequate water were ineffective at preventing UTIs. In summary, women had low self-efficacy regards tackling AMR and managing their health. Conclusion: Misconceptions about how AMR affects society vs the individual translated into viewing it as a future problem to be tackled by the health-care sector. Consequently, AMR requires reconceptualization as a current problem requiring collective action. This research also indicates women endorse a biomedical model of UTIs in pregnancy which attributes resolving illness to interventions such as medicines, implying an automatic reliance on antibiotics. Subsequently, there is a need for self-efficacy by focusing on a behavioural model which emphasizes behaviours for infection prevention, thus reducing the need for antibiotics.

Experiences of urinary tract infection: A systematic review and meta‐ethnography

“…Two studies looked at those who used clean intermittent self‐catheterization (CISC) 25,26 . Other specific participant groups included pregnant women, 31,32,38 the older population, 27,37 and those with spinal cord injury 28 …”

“…23,24,30,34 Two studies looked at those who used clean intermittent self-catheterization (CISC). 25,26 Other specific participant groups included pregnant women, 31,32,38 the older population, 27,37 and those with spinal cord injury. 28 We extracted 88 concepts from the primary studies and organized these into 34 conceptual categories, further refined into nine themes (Table 4): ( 1) the impact of UTI on my whole body; (2) impact on quality of life, activities, and the associated psychological toll; (3) I know my body and my experience has taught me when I need to seek care; (4) worry and the transition to medicalization; (5) antibiotics are a last resort; (6) Antibiotics are a valuable treatment approach; (7) being heard, seen, and cared for with dignity; (8) self-judgment; and (9) the end of the road, a need for information and cure.…”

“…Ghouri et al 31 To explore views about antimicrobial resistance (AMR) in women who experienced UTIs in pregnancy.…”

Antibiotic Prescribing in Primary Care for Urinary Tract Infections (UTIs) in Pregnancy: An Audit Study

“…Studies exploring the perceptions of women who experienced UTIs in pregnancy have shown that they were concerned but uncertain on how to tackle antimicrobial resistance [ 36 , 37 ]. One of the studies also showed that while women like to be informed and make decisions for their health, they trust and place high importance on the opinion of the healthcare professional involved in their care [ 36 ].…”

Using Large-scale Social Media Analytics to Understand Patient Perspectives About Urinary Tract Infections: Thematic Analysis

“…Ghouri et al [13] previously conducted 15 telephone interviews with women with prior documented UTI and described feelings of hopelessness and lack of support in this group. Our study highlights the support experienced by patients with UTI who exchanged information online.…”