Only 25% of patients with a UTI give a urine sample to confirm diagnosis

Most patients with urinary tract infections (UTIs) receive antibiotics on the same day as diagnosis, but just a quarter have evidence of a urine sample being taken in their electronic health records, study results published in The Lancet show (12 August 2019).

As a result, the researchers said existing laboratory tests for UTIs are having little impact on the prescribing of antibiotics.

The study, which was funded by NHS Improvement, examined the investigation and antibiotic treatment of UTIs, and subsequent antibiotic re-prescription within 28  days across 390 primary care practices, to examine opportunities for improved antimicrobial stewardship.

The researchers examined a cohort of patients given a lower UTI diagnosis between 2011–2015. In total, 494,675 UTIs were diagnosed in 300,354 patients. Same-day antibiotics were prescribed for 85.7% of the UTIs, but urine sampling was only undertaken in 25.0%.

Overall, the most common antibiotics initially prescribed were trimethoprim (56.8%) and nitrofurantoin (23.9%) and the researchers found little diversity in antibiotic treatment.

The antibiotic re-prescription rate was low (4.1%), but gradually increased over time and was seen on average in more than 3,000 patients per year. Re-prescription of the same antibiotic occurred in around a fifth of these patients, which the authors described as “surprisingly frequently” considering that the practice is contrary to guidelines from the National institute for Health and Care Excellence
which say that a different antibiotic should be given if the first choice has failed. 

Mar Pujades Rodriguez, an academic fellow at the University of Leeds and lead author of the study, said: “Doctors are currently limited in their options when somebody shows signs of having a UTI, and they 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.”