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Deutsch Intern
Department of General Practice

Systematic Literature Reviews

Systematic literature reviews are particularly important in clinical specialties of medicine because of the "evidence-based" reporting of findings on a particular research question for practice (and sometimes for policy). Unlike evaluative literature reviews or "simple" reviews, systematic literature reviews are characterized by the fact that both the selection of sources is transparently presented and the literature search and selection and the method of content evaluation are described in detail.

 

Prognostic factors in women with urinary tract infections: Systematic literature review and meta-analysis of observational studies.

Urinary tract infections are among the most common consultations in primary care. Although many studies on prognostic factors or risk factors for severe disease progression can be found in the literature, these studies have not yet been summarized, or reviewed, in a systematic review and meta-analysis. The results of this study will inform further research in this area, including the development of risk scores and gaps in the literature. In addition, the study will help primary care physicians decide on the most appropriate treatment pathways for these patients.

Current status: Data analysis
Lead reviewer: Peter Kurotschka (kurotschka_p@ukw.de), Mark H Ebell

Experiences and perspectives of health care professionals in the management of urinary tract infections: Systematic Review of Qualitative Studies, Meta-Summary, and Meta-Synthesis.

Attitudes, views, expectations, and perceptions of the various actors involved in care (i.e., medical and nursing staff, patients, and their caregivers) as well as cultural and societal dimensions are important for health behavior and are increasingly being researched using qualitative methods. This has also been demonstrated for infectious diseases, such as urinary tract infections. To date, no studies have systematically summarized qualitative research on the perspectives of health care professionals (physicians*, nurses, MFA, pharmacists, etc.) regarding urinary tract infections. By filling this research gap, we aim to provide the current state of qualitative evidence and inform clinicians about needs and expectations related to UTIs that are considered important by several key informants.

Current status: Data analysis
Lead reviewer: Peter Kurotschka (kurotschka_p@ukw.de)

Reasons for discontinuation of SGLT2 inhibitors under real-world treatment conditions: A Systematic Review and Meta-Analysis of Observational Studies.

Background: As a relatively new class of antidiabetic drugs, sodium-glucose co-transporter-2 inhibitors (SGLT2-I) are gaining importance outside their original field of application due to their cardioprotective and nephroprotective properties. Persistence and adherence to medication have a major impact on medical treatment. Previous studies provide very heterogeneous information on adherence with this group of substances. Pooled data from pivotal trials and randomized controlled trials (RCTs) highlighting the cardio-renal benefits of the substances show very low discontinuation rates.

Research questions: How many patients in an outpatient setting take SGLT2-I long-term? It is well known that well-studied substances that have been shown to prevent mortality are often not taken regularly (adherence) and if they are, they are not taken permanently (persistence).

Methods: Systematic literature search aimed to identify factors contributing to poor persistence and adherence of SGLT2-I in practice.
We identified 1922 electronic literature sources in 3 databases; after removal of duplicates, 1305 abstracts remained. Sixty-three publications were screened in full text, and four additional publications were identified by hand. A total of 6 studies met the a priori defined inclusion criteria: 4052 patients from 8 countries with new initiation of SGLT2-I therapy at an average observation time of 13+/- 2 months were analyzed. 740 discontinuation events were described.

Current status: Data extraction.
Lead reviewer: Felix Kannapin (kannapin_f@ukw.de)

UTI-IPD strategies to reduce antibiotic consumption in women with uncomplicated urinary tract infections in primary care.

As part of the project "UTI-IPD - Strategies to reduce antibiotic consumption in women with uncomplicated urinary tract infections in primary care", funded by the German Federal Ministry of Education and Research (BMBF), individual patient data from clinical trials on reducing antibiotic consumption were analyzed across studies in cooperation with the Institute of Medical Statistics at the University of Göttingen.

Over 9000 publications were searched for clinical trials comparing non-antibiotic treatment strategies (analgesics, herbal remedies, and placebo) with immediate antibiotics. A total of nine studies were included. 

The analyses clearly demonstrate that non-antibiotic strategies are associated overall with a higher symptom burden as well as a more frequent occurrence of complications such as pyelonephritis. However, further analysis revealed that this inferiority was not demonstrable in patients without erythrocytes and bacterial growth in the urine. Point-of-care testing to detect erythrocytes and bacteria in the urine at the time of treatment decision could thus facilitate therapy with nonantibiotic strategies consistent with antibiotic stewardship.

Publications:

Reducing antibiotic use in uncomplicated urinary tract infections in adult women: a systematic review and individual participant data meta-analysis - ScienceDirect

- Strategies to reduce antibiotic use in women with uncomplicated urinary tract infection in primary care: protocol of a systematic review and meta-analysis including individual patient data - PubMed (nih.gov)

Lead Reviewer: Yvonne Kaußner (kaußner_y@ukw.de)

The study received the David Sackett Award of the Network Evidence-Based Medicine e.V. in March 2023.