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Haran Devakumar

North Middlesex University Hospital, United Kingdom

Title: Improving the Diagnosis and Management of Lower Urinary Tract Infections in Older People

Biography

Biography: Haran Devakumar

Abstract

Aim - Achieving 90% of antibiotic prescriptions for Lower UTI in older people meeting UK NICE guidance for Lower UTI and PHE diagnosis of UTI guidance in terms of diagnosis and treatment

1) Diagnosis of Lower UTI based on documented clinical signs or symptoms

2) Diagnosis excluded use of urine dip stick

3) Urine sample sent to microbiology

4) Empirical antibiotic prescribed following NICE Guideline

Methods - All patients with a diagnosis of Lower UTI on discharge from ED were audited over 9 months (April – December 2019). Denominator: Total number of antibiotic prescriptions for all patients aged 65+, with a diagnosis of Lower UTI in North Middlesex ED. Numerator: Of the denominator, the number where the 4 audit criteria for diagnosis and treatment following PHE UTI diagnostic and NICE guidance are met and recorded. Exclusions: Recurrent UTI, pyelonephritis, catheter associated UTI, sepsis.

Background - In the 2016 national antibiotic point prevalence survey, 62.5% of antibiotic prescriptions for lower UTIs were deemed inappropriate. 50% of older adults and MOST with a urinary catheter will have asymptomatic bacteriuria. This is NOT harmful but will give a positive dipstick which can lead to inappropriate prescribing, promoting antibacterial resistance and healthcare associated infections i.e. Clostridium difficle.

Conclusion - We used Quality Improvement Methodology at the frontline to make significant and sustainable improvements in the diagnosis and management of Lower UTI in the over 65’s. Prescribed antibiotics are now compliant with NICE in 90% of cases compared with 44% in cycle 1. Nitrofurantoin and Fosfomycin now make-up 83% of prescriptions, compared to 18% in cycle 1. The use of urinary dipsticks has been dramatically reduced. The number of urine samples sent to the laboratory has increased which is essential to ensuring correct patient management and working towards the ambition to decrease gram negative bacteraemias by 50% by 2023.