We are entering an era when people may become seriously unwell and even die as a result of simple infections because increased antibiotic use has led to a rise in bacterial resistance.
As the independent review on Antimicrobial Resistance found, there could be up to 10 million deaths globally and a cost of £66 trillion by 2050 unless we act. One of the key ways to address this is to minimise unnecessary prescriptions.
Urinary tract infections (UTIs) are very common, with NHS Choices estimating that half of all women in the UK will have a UTI at least once in their life and that one out of every 2,000 healthy men will develop one each year. Unsurprisingly, we are now seeing a growing number of UTIs that are resistant to common antibiotics. I am convinced that many prescriptions for suspected UTIs are being given misguidedly, and that we can take simple steps to tackle this.
“I am convinced that many prescriptions for suspected UTIs are being given misguidedly”
During a recent study day attended by healthcare workers across acute and primary care I discovered that it is still common practice in some hospitals, care homes and primary care to dipstick test a urine specimen. As NICE and SIGN 88 guidelines show, this test alone is not enough to diagnose a UTI. However, dipstick tests are frequently used and often lead to a prescription for antibiotics.
Nurses like me have been taught that if a patient has cloudy, strong smelling urine that infection is the likely cause, when in fact it is not. There are many other reasons for these urinary ’symptoms’. Lack of fluid, poor personal hygiene, diabetes, presence of mucous or an indwelling urinary catheter could all be possible. Diagnosis depends on assessment of clinical symptoms including pain and difficulty passing urine, temperature and careful interpretation of microbiological tests. Even the presence of bacteria in urine is not enough to diagnose a UTI as this may be a by product of an indwelling catheter.
“If you are looking for bacteria, will it tell you anything you do not already know?”
The healthcare workers I spoke to explained that the medical teams they worked with had confidence to prescribe antibiotics based on what they were being told, but with no microbiological results on which to base this.
I want all health workers to stop and think before conducting a dipstick test on urine. If you are looking for glucose, blood or protein, these are all good reasons to carry out the test. But if you are looking for bacteria, will it tell you anything you do not already know?
Furthermore, antibiotics are not always necessary to treat UTIs; most cystitis and mild bacteriuria can be helped by simple fluids and advice. Of course, antibiotics are not without their own risks, and there are numerous examples of allergic reactions or C. difficle infection, following a single dose of an antibiotic.
The Infection Prevention Society recognises that we certainly need new treatments for infections, which is why we support the antibiotic action campaign. But only carrying out dipstick tests when they are really necessary is a simple step towards helping reduce the over prescribing of antibiotics. Antibiotics are precious. Let’s work together to ensure we only use them when they are really needed.
Elaine Ross is a member of the Infection Prevention Society’s Board and Infection Control Manager at NHS Dumfries & Galloway