While a UTI was a relatively common problem, the study authors noted that in some cases complications occurred when the infection spread to cause kidney infection or sepsis.
“They urgently need access to accurate rapid diagnostics tests”
Mar Pujades Rodriguez
But they said current “bedside” dipstick tests to screen a urine sample for infection were inaccurate and laboratory tests – recommended for groups such as children and adult men – were slow, taking two to three days to return results.
They argued that, without access to a reliable test, clinicians risk prescribing unnecessary antibiotic treatments, which increase the risk of antibacterial resistance.
Their new research looked at nearly 500,000 cases of UTIs in patients in England, treated between 2011 and 2015, using records held at 390 GP practices.
Only 17% of patients treated for a UTI had a laboratory urine test to diagnose their problem, according to the study by the University of Leeds and funded by NHS Improvement.
It also found tests were not carried out more often in men than women, nor in the 4% of patients who returned for a second treatment because their symptoms persisted, contrary to NHS guidance.
The researchers argued, therefore, that existing laboratory tests for UTIs were having little impact on the prescribing of antibiotics.
“The potential contribution this is causing to antibiotic resistance might be very significant”
Mar Pujades Rodriguez
Meanwhile, the study found one in five patients who returned for a second round of treatment were prescribed the same antibiotic as before – not recommended by the National Institute for Health and Care Excellence.
As a result, thousands of patients across England have received repeat scripts that have little chance of curing their infection, but may increase the risk of resistance developing, warned the authors.
Published in the Lancet journal EClinicalMedicine, the authors said their findings showed that more accurate and rapid testing capabilities were needed for UTI, as well as different antibiotic strategies.
Study author Dr Mar Pujades Rodriguez said clinicians were “limited in their options” when a patient showed signs of a UTI, and “urgently need access to accurate rapid diagnostics tests”.
“UTIs are one of the most common reasons that antibiotics are prescribed, so the potential contribution this is causing to antibiotic resistance might be very significant,” she said.
“In addition, many patients may be making things worse by taking leftover antibiotics that they have been prescribed and using them to treat other infections, or by not finishing their course of treatment,” she added.
Mar Pujades Rodriguez
Source: University of Leeds
Dr Mar Pujades Rodriguez
Worryingly, the study also found that the rate at which male patients had to return for a second treatment for the same UTI increased by about 20% over the study period – from 5.2% to 6.2%.
This increase in re-prescribing of antibiotics needed to be monitored, as it could be related to an increase in antibiotic resistance, warned the researchers.
In addition, they found that patients who had been prescribed antibiotics more recently were more likely to need further treatment to tackle their UTI.
Patients prescribed antibiotics in the past three to six months were 37% more likely to require a second treatment, compared with those who had not been given antibiotics in the last year.
Those who had been prescribed antibiotics in the past one to three months were nearly twice as likely to need a second treatment.
Meanwhile, those prescribed antibiotics in the past month were more than three times more likely to need a second treatment, compared to those who had not been given antibiotics in the last year.
https://www.nursingtimes.net/news/primary-care/better-tests-needed-for-urinary-tract-infections-say-researchers/7029943.article