Urinary Tract Infections
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Urinary tract infections (UTI) are the second largest single group of healthcare associated infections (HCAIs) in the UK, accounting for 19% of all HCAIs (Health Protection Agency,2011). UTIs are also the second most common clinical indication for empirical antimicrobial treatment, and urine samples constitute the largest single category of specimens examined in most medical microbiology laboratories. The diagnosis and management of patients with suspected or confirmed UTI varies greatly across organisations, often resulting in the inappropriate use of antimicrobials and increasing the risk of drug resistance and further complications (Department of Health, 2013). Diagnosing UTI is particularly difficult in elderly patients. They are more likely to have asymptomatic bacteriuria (presence of bacteria in the urine) and may present with non-classical signs and symptoms, such as acute confusion and falls (SIGN, 2012). An audit was undertaken (n=129) within the admission units (AMU, CDU, ECC) to determine the frequency of urine dip stick testing in those with ? UTI. Also to establish the number of urine cultures submitted and use of antimicrobials in these patients.
The mean age of all patients presenting with a suspected UTI was 75yrs and mean age for those that had a urine dip performed was 83yrs.
10% of patients had a urine dip performed in catheterised patients.
The commonest antibiotic prescribed was coamoxiclav - 67% and Trimethoprim 21%. Just over half of patients presenting with a UTI had a urine culture obtained. It is imperative cultures are obtained in patients with clinical signs or symptoms of a UTI e.g. temperature, pain, dysuria, unexplained delirium, cloudy urine.
There are a variety of ways to obtain a urine culture such as the use of female urinals, Newcastle pads and intermittent catheters as well as encouraging fluids where able.
- Remember DO NOT dip patients with long term catheters
- Check C&S results when available
- Do not use dip sticks in elderly patients > 65yrs of age
- Help to reduce antimicrobial resistance
A urine dipstick test is a simple diagnostic tool used to determine pathological changes in a patient’s urine sample. The presence of the leukocyte esterase (an enzyme released by white blood cells), together with the presence of chemical units called nitrites not found in normal urine, may indicate a UTI —nitrites are produced by the reduction of nitrates by Gram-negative bacteria such as Escherichia coli. Urine dipstick testing should not be undertaken in patients witha long-standing urinary catheter in place as these patients will have asymptomatic bacteriuria. A positive dipstick test for leucocyte esterase or nitrite is not able to differentiate between asymptomatic bacteriuria and UTI, therefore, signs and symptoms should always be considered before a diagnosis is made. Also, the level of asymptomatic bacteriuria increases with age and is reported to be as high as 40% in elderly women making the use of dipstick testing questionable in this group
Urine quality indicators for : Dip -stick undertaken, urine culture taken, those on antimicrobials with no culture/dip.
% of patients with suspected UTI had a dip-stick performed within 6 hrs of admission
number of patients who had a urine culture taken if dip +ve
patients commenced on antibiotics with no culture
What does this data tell us?
Next steps to be taken