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Cystitis AcuteMicUTINCT05667207

Dipsticks and Microscopy to Reduce Antibiotic Use in Women's Urinary Tract Infections: a Pilot Trial (MicUTI)

A study testing Point-of-care microscopy and dipstick guided management in people with Cystitis Acute and Antibiotic Resistant Infection, run by Wuerzburg University Hospital at 2 sites in Germany.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

With the aim to pilot a full-scaled trial to reduce unnecessary antibiotics in women with suspected uncomplicated urinary tract infections, twenty general practices in Bavaria, Germany, will be randomized to deliver patient management based on phase-contrast microscopy and urinary dipsticks or to usual care. Read more about this study

Who is it for?
Ages 18 to 70 years, women only
What is being tested?
Point-of-care microscopy and dipstick guided management
Could I receive a placebo?
No, everyone receives an active treatment
How many people
154 participants
Where
2 sitesGermany
Study dates
15 Jun 2023to 30 Apr 2024
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 70 years
  • Women only
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Women with at least two of dysuria, frequency, urgency, lower abdominal pain or hematuria.

Who cannot join

  • Signs of a complicated UTI (anamnesis of fever, chills or flank pain)
  • Clinically relevant immunosuppression (i.e., current use of any immunosup-pressive therapy, congenital or acquired disorders of immunity)
  • Acute or chronic functional or anatomical variations in urinary tract except renal insufficiency grade II/IIIa
  • Permanent bladder catheter or use of bladder catheter within the past two weeks
  • UTI within the past two weeks
  • Use of any antibiotic within the past two weeks
Show all 11Show fewer
  • Accommodation in a nursing home or hospital stay within the past two weeks
  • Severe neurologic or psychiatric illness, severe dementia or severe substance use disorder
  • Other severe diseases
  • Being unable to understand the informed consent or to complete the patient diary
  • Known pregnancy

Trial locations and contacts

2 sites in 1 country.

Germany2 sites
  • Stefanie Stark

    Erlangen, 91054

  • University Hospital Würzburg

    Würzburg, 97080

Other trials in Germany

About this study

Official title: Dipsticks and Point-of-care Microscopy to Reduce Antibiotic Use in Women With Uncomplicated Urinary Tract Infections: a Cluster-randomized Controlled Pilot Trial

With the aim to pilot a full-scaled trial to reduce unnecessary antibiotics in women with suspected uncomplicated urinary tract infections, twenty general practices in Bavaria, Germany, will be randomized to deliver patient management based on phase-contrast microscopy and urinary dipsticks or to usual care. Primary endpoints are recruitment and retention rates.

Read the detailed description

Introduction: Uncomplicated urinary tract infections (UTIs) in women are among the most common infections encountered in primary care after those of the respiratory tract. They are often self-limiting, even though antibiotics are prescribed for almost all women presenting with suggestive clinical features. Efforts directed to tackle antimicrobial resistance led to primary care randomized controlled trials (RCTs) that investigated alternative treatment strategies in these patients. While reducing antibiotic use substantially, none of the experimental treatments showed non-inferiority to antibiotics with respect to clinical outcomes such as symptom duration, symptom burden, and pyelonephritis. Evidence suggests that rapid point-of-care (POC) tests to detect bacteria and erythrocytes in urine at presentation may help primary care clinicians to select women with uncomplicated UTIs (unUTIs) in whom antibiotics can be withheld without affecting clinical outcomes. The aim of this study is to pilot a full-scaled primary care RCT to evaluate the effects of a POC diagnosis and treatment algorithm based on a combination of phase-contrast microscopy and urinary dipsticks on antibiotic use in women with symptoms of an unUTI.

Methods and analysis: MicUTI (Microscopy in UTI) is a pragmatic open-label two -arm parallel pilot cluster-RCT. Twenty general practices affiliated to the Bavarian Practice Based Research Network (BayFoNet) in Germany will be randomly assigned to deliver patient management based on POC-tests (POCTs) or to the usual care arm. Urine samples will be obtained at presentation for POCTs and microbiological analysis. All patients will be followed-up using a self-directed patient diary completed until day 7 from inclusion or until symptom resolution (up to day 14), and through telephone-calls at day 28. An electronic medical record review is performed in case of missing follow-up information.

Primary endpoints are patient enrollment and retention rates. Exploratory endpoints include antibiotic use for UTI at day 28, time to symptom resolution, symptom burden, the number of recurrent and upper UTIs and re-consultations, and diagnostic accuracy (POCTs vs. urine culture as reference standard).

Ethics, data protection and trial registration: The trial will be conducted in accordance to the declaration of Helsinki and the relevant data protection regulations. Institutional review board approval: 109/22-sc (December 16, 2022)

Being tested
Point-of-care microscopy and dipstick guided management
Keywords
General Practice, Primary care, randomized controlled trial, randomized clinical trial, cluster-randomized trial, pilot study, feasibility, microscopy, urinary dipsticks, clinical decision algorithm, point-of-care test
Medical subject headings
Medication Adherence

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Point-of-care microscopy and dipstick guided managementDiagnostic test

    GPs will be encouraged to apply the following diagnosis and treatment algorithm (figure 1) to consenting women, taking their preferences into account:

    1. If POCTs are positive for bacteria by microscopy and/or for erythrocytes by dipsticks the GP issues, at his/her own clinical judgement, a delayed or immediate prescription for an antibiotic.10 In the MicUTI intervention, delayed prescription is defined as issuing an antibiotic prescription with the advice to take the medication only when symptoms do not improve or worsen in 48 hours.
    2. If POCTs are negative for bacteria and erythrocytes, the GP advises for self-help remedies according to guidelines and to do without antibiotics Study specific training in point-of-care microscopy will be provided to intervention practices.
Study groups in NCT05667207
Study groupRoleWhat they receive
Point-of-care microscopy and dipstick guided managementExperimentalGPs whose practice is allocated to the intervention will have their management guided by POCTs, namely phase-contrast microscopy and urinary dipsticks for all patients consenting for participation.
Receives: Diagnostic Test: Point-of-care microscopy and dipstick guided management
Usual careNo interventionPractices in the control arm will not have their management guided by POCTs. They will perform usual care. The treatment decision is usually based on symptoms and dip-stick test results (i.e., erythrocytes, leukocytes, nitrites).

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Recruitment efficacy

    Number of participants enrolled per site over 6 months of trial duration

    Measured: 6 months (duration of the trial in each study site)

  2. Retention

    Percentage of complete follow-ups over 28 days

    Measured: 28 days (duration of the trial for each enrolled patient)

Secondary outcomes (11)
  1. Total antibiotic use

    Number of antibiotic prescriptions per patient with UTI within 28 days

    Measured: 28 days

  2. Antibiotic doses

    Defined daily doses of the prescribed antibiotics per patient with UTI within 28 days

    Measured: 28 days

  3. Inappropriate antibiotic use

    Percentage of patients with symptoms of UTI who were prescribed antibiotics among those with negative urine cultures

    Measured: Day 0

  4. Immediate and delayed antibiotics

    Number of immediate and delayed antibiotic prescriptions for uncomplicated UTI at initial consultation

    Measured: Day 0

  5. Early relapses

    Number of early relapses of UTI (days 0-14)

    Measured: Days 0-14

  6. Recurrent urinary tract infections (UTIs)

    Number of recurrent UTIs (day 15-28)

    Measured: Days 15-28

  7. Upper UTIs

    Number of upper UTIs within 28 days

    Measured: 28 days

  8. Re-consultations

    Number of consultations due to UTI (or symptoms of UTI) within 28 days

    Measured: 28 days

  9. Symptom resolution

    Time to symptom resolution defined as a maximum of 1 point in each of the UTI-SIQ-8 items

    Measured: Days 0-7 (or max. 14 if symptoms last longer)

  10. Symptom Burden

    Total symptom burden on days 0-7 (area under the curve of the UTI-SIQ-8 total symptom score)

    Measured: Days 0-14

  11. Diagnostic accuracy

    Diagnostic accuracy of microscopy +/- dipstick compared to the standard (urine culture)

    Measured: Day 0

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted28 Dec 2022
  2. Study start15 Jun 2023
  3. Primary completion30 Apr 2024
  4. Study completion30 Apr 2024

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Other
Allocation
Randomised
Intervention model
Parallel groups
Model description
Pilot study (feasibility)
Masking
None (open label)
Enrolment
154 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05667207
Sponsor's protocol ID
109/22-sc
Acronym
MicUTI
Status last verified
Nov 2023
First submitted
19 Dec 2022
Last updated
24 Jul 2024
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Kurotschka PK, Borgulya G, Bucher E, Endrich I, Figueiras A, Gensichen J, Hay AD, Hapfelmeier A, Kretzschmann C, Kurzai O, Lam TT, Massidda O, Sanftenberg L, Schmiemann G, Schneider A, Simmenroth A, Stark S, Warkentin L, Ebell MH, Gagyor I; Bavarian Practice-Based Research Network (BayFoNet). Dipsticks and point-of-care Microscopy to reduce antibiotic use in women with an uncomplicated Urinary Tract Infection (MicUTI): protocol of a randomised controlled pilot trial in primary care. BMJ Open. 2024 Mar 29;14(3):e079345. doi: 10.1136/bmjopen-2023-079345.

    PubMed 38553055
  • Kurotschka PK, Koch MJ, Bucher E, Figueiras A, Gensichen J, Hapfelmeier A, Hay AD, Kretzschmann C, Kurzai O, Lam TT, Lasher K, Massidda O, Sanftenberg L, Schmiemann G, Schneider A, Simmenroth A, Stark S, Warkentin L, Ebell MH, Gagyor I; Bavarian Practice-Based Research Network (BayFoNet). Dipsticks and point-of-care Microscopy in Urinary Tract Infections in primary care: Results of the MicUTI pilot cluster randomised controlled trial. PLoS One. 2025 Oct 8;20(10):e0332390. doi: 10.1371/journal.pone.0332390. eCollection 2025.

    PubMed 41060972
  • Sanftenberg L, Schnaidt AL, Eck S, Schneider A, Bucher E, Kurotschka PK, Gagyor I, Klanke M, Stark S, Kuhlein T, Walter F, Roos M, Dreischulte T, Gensichen J; BayFoNet study group. Experiences of general practice teams and their patients with clinical research-a mixed-methods process evaluation of the Bavarian Research Practice Network (BayFoNet). BMC Prim Care. 2025 Feb 28;26(1):59. doi: 10.1186/s12875-025-02744-x.

    PubMed 40021995
  • Sanftenberg L, Stofella J, Mayr K, Nassehi A, Hardtlein A, Stark S, Kuhlein T, Kurotschka PK, Gagyor I, Eck S, Schneider A, Bossenecker M, Roos M, Dreischulte T, Gensichen J; BayFoNet study group. Expectations of general practitioners on a practice based research network in Germany- a qualitative study within the Bavarian Research Practice Network (BayFoNet). BMC Prim Care. 2024 Jan 2;25(1):10. doi: 10.1186/s12875-023-02239-7.

    PubMed 38166677
  • Sanftenberg L, Dreischulte T, Hardtlein A, Kosub H, Gagyor I, Kurotschka PK, Kuhlein T, Burggraf L, Eck S, Roos M, Gensichen J; BayFoNet-Research-Group. Process evaluation in practice based research networks: a study protocol for a mixed-methods implementation study. BMJ Open. 2023 Jul 12;13(7):e065947. doi: 10.1136/bmjopen-2022-065947.

    PubMed 37438058

Questions about this trial

What is this clinical trial studying?

A study testing Point-of-care microscopy and dipstick guided management in people with Cystitis Acute and Antibiotic Resistant Infection, run by Wuerzburg University Hospital at 2 sites in Germany.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 1 inclusion and 11 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 24 Jul 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 2 sites in Germany. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Recruitment efficacy (time frame: 6 months (duration of the trial in each study site)). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05667207, which also lists 5 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 24 Jul 2024.

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