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Urinary tract infections (UTIs) are common in general practice, and antibiotic resistance is often seen. Urine cultures are advised by the Dutch national UTI guideline for patients at high risk of UTI complications. Prudent use of antibiotics and taking into account national guidelines and urine culture results are important to combat antibiotic resistance in general practice.
To identify subgroups of UTI patients in which the use of urine cultures and antibiotic prescriptions deviates from the national guidelines.
We investigated associations of several characteristics with urine culture orders in patients with UTI in 2015 from seven Dutch general practices (n=1295). These included subgroups at risk for UTI complications, comorbidities, age and history of UTI recurrence. In addition, we assessed the level of adherence to the guideline for antibiotic prescriptions in subgroups at risks for UTI complications.
Urine cultures were ordered in 17% (n=221) of patients, more frequently in high-risk patients (32%) than in low-risk patients (7%), for UTI complications (OR=6.4; 95% CI 4.6–9.0). In low-risk patients, 91% received antibiotics that were recommended in the guideline. For high-risk patients this percentage ranged widely, and was particularly low in the risk groups with signs of tissue invasion (29–50%). Diagnostic and therapeutic adequacy can still be improved by increasing the adherence to the guideline in UTI patients at high risk for complications. This may contribute to containing antibiotic resistance in UTI by ordering urine cultures and use the results to adjust prescriptions to antibiotic susceptibility of the uropathogen.
Observations of atmospheric reactive nitrogen (Nr) deposition are severely restricted in spatial extent and type. The chain of processes leading to atmospheric deposition emissions, atmospheric dispersion, chemical transformation and eventual loss from the atmosphere is extremely complex and therefore currently, observations can only address part of this chain.
Modelling provides a way of estimating atmospheric transport and deposition of Nr at the European scale. A description of the different model types is provided.
Current deposition estimates from models are compared with observations from European air chemistry monitoring networks.
The main focus of the chapter is at the European scale; however, both local variability and and intercontinental Nr transfers are also addressed.
Key findings/state of knowledge
Atmospheric deposition is a major input of Nr for European terrestrial and freshwater ecosystems as well as coastal sea areas.
Models are key tools to integrate our understanding of atmospheric chemistry and transport, and are essential for estimating the spatial distribution of deposition, and to support the formulation of air pollution control strategies.
Our knowledge of the reliability of models for deposition estimates is, however, limited, since we have so few observational constraints on many key parameters.
Total Nr deposition estimates cannot be directly assessed because of a lack of measurements, especially of the Nr dry deposition component. Differences among European regional models can be significant, however, e.g. 30% in some areas, and substantially more than this for specific locations.
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