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Investigating the epidemiology of community-onset lower urinary tract infections

Aryee, Anna Maria Amanuah; (2022) Investigating the epidemiology of community-onset lower urinary tract infections. Doctoral thesis (Ph.D), UCL (University College London). Green open access

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Abstract

The rise of antibiotic resistance (ABR), the ability of bacteria to resist the activity of antibiotics, is a threat to patient care. In the UK, there has been a consistent increase in the numbers and proportions of antibiotic resistant infections. Strong evidence exists of a link between antibiotic prescribing and ABR, and interventions have focused on improved and reduced antibiotic prescribing. Urinary tract infection (UTI) is the commonest bacterial community-onset infection, and improved prescribing is an important focus for reducing ABR. In chapter one I give an overview of ABR in England. I provide a background to the clinical presentation, spectrum of disease and microbiological diagnosis of UTI, and set out the rationale for the thesis. In chapter two I describe the data sources used for the studies presented in chapters 3, 4 and 6. In chapter three I present a retrospective cohort study using linked primary care, secondary care and microbiology data investigating the risk factors for hospitalisation (urinary infection-related and all-cause) following consultation for community-onset lower UTI (COLUTI) in primary care. In chapter four I present a retrospective cohort study using linked primary care, secondary care and microbiology data from patients treated for cultureconfirmed COLUTI. I investigate the effect of discordant antibiotic treatment (treatment to which the urine culture organism was resistant) on urinary infection-related hospital admission and reconsultation in primary care. In chapter five I present a systematic review of the risk factors for communityonset Escherichia coli bloodstream infection. In chapter six I present a retrospective cohort study of patients admitted to hospital with community-onset Gram-negative bloodstream infection, examining the effect of discordant empirical antibiotic therapy on in-hospital death and ICU admission. In chapter seven I summarise my research findings, discuss the limitations of the thesis, highlight the practice and policy implications and suggest future research priorities.

Type: Thesis (Doctoral)
Qualification: Ph.D
Title: Investigating the epidemiology of community-onset lower urinary tract infections
Open access status: An open access version is available from UCL Discovery
Language: English
Additional information: Copyright © The Author 2022. Original content in this thesis is licensed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) Licence (https://creativecommons.org/licenses/by-nc/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request.
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Health Informatics
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
URI: https://discovery.ucl.ac.uk/id/eprint/10146387
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