An Audit on Trust Guidelines Compliance on Management of Urinary Tract Infections in Over 65s

Introduction:

Urinary tract infections (UTIs) are the second most common community-acquired infection and the leading cause of hospital infections in individuals over 65 years. UTI treatment is a major driver of antibiotic resistance (AMR), with E. coli being the primary pathogen causing this in the UK. Further, asymptomatic bacteremia is common in over 65s and does not lead to increased morbidity. However, unnecessary antibiotic exposure increases the risk of harm, including AMR and C.difficile infection, contributing to the rising AMR-related mortality.

Method:

This study aimed to assess compliance with UTI management guidelines in the Geriatrics wards at Royal Stoke Hospital, comparing practice with University Hospitals of North Midlands (UHNM) guidelines.

The UHNM guidelines for over 65s recommend starting antibiotics promptly for suspected urosepsis or pyelonephritis. But for suspected UTIs, antibiotics should only be started if multiple new symptoms are present, such as dysuria, urgency, incontinence, delirium, suprapubic pain, or haematuria. In cases with only one symptom, particularly delirium, antibiotics are not indicated, and alternative diagnoses should be considered.

Results:

The audit consisted of 40 patients diagnosed with simple UTIs, and found that 38% were catheterized before diagnosis, and 18% had alternative diagnoses, such as hospital-acquired pneumonia. Urine cultures were performed in only 25% of cases before starting antibiotics. With the most prescribed antibiotic being Temocillin (40%). Notably, 62% of patients did not meet the UTI diagnostic criteria, primarily because antibiotics were started before urine culture results or when only one symptom, such as delirium, was present.

Conclusion:

This study highlights the misdiagnosis and inappropriate treatment of UTIs in patients over 65s, which contributes to AMR and worsens patient outcomes. And proves adhering to guidelines is essential for improving care and reducing unnecessary antibiotic use, which we will further implement by increasing healthcare professionals' education on the topic.