Management of urinary tract infections in the community: a clinical audit and patient survey

Stacey Jayne Fisher; Clive Graham; James Kennard; Leon Jonker

doi:10.3399/BJGPO.2022.0191

Management of urinary tract infections in the community: a clinical audit and patient survey

BJGP Open. 2023 Dec 19;7(4):BJGPO.2022.0191. doi: 10.3399/BJGPO.2022.0191. Print 2023 Dec.

Authors

Stacey Jayne Fisher¹, Clive Graham², James Kennard³, Leon Jonker⁴

Affiliations

¹ Research & Development Department, North Cumbria Integrated Care NHS Foundation Trust, Penrith, UK.
² Microbiology Department, North Cumbria Integrated Care NHS Foundation Trust, Carlisle, UK.
³ Banbury Cross Health Centre, Banbury, UK.
⁴ Research & Development Department, North Cumbria Integrated Care NHS Foundation Trust, Penrith, UK leon.jonker@ncic.nhs.uk.

PMID: 37391209
DOI: 10.3399/BJGPO.2022.0191

Abstract

Background: Urinary tract infection (UTI) is a common ailment but can develop into sepsis. The outcomes related to UTI may potentially be affected by both patient and clinician management of UTI.

Aim: To explore the circumstances around a single UTI episode to determine whether there are patient and clinician-related variables that may contribute to differences in management.

Design & setting: Survey and clinical audit in 12 general practices in England.

Method: Patients (n = 504) completed a bespoke survey and their corresponding index UTI consultation was audited. The TARGET (Treat Antibiotics Responsibly, Guidance, Education and Tools) UTI audit toolkit was utilised.

Results: A significantly higher proportion of females compared with males used self-management measures. Increase in fluid intake was 78% for females aged <65 years and 71% for females aged >65 years compared with 53% for males (P<0.001, Χ² test). Analgesic use was 50% for females aged <65 years and 41% for females aged >65 years compared with 36% for males (P = 0.036, Χ² test). Males also indicated they lacked UTI knowledge when compared with females (P = 0.002, Kruskal-Wallis test). Males also claimed to have waited significantly longer for a consultation appointment (P = 0.027, Χ² test). Antibiotics were prescribed in 98% of all cases, with adherence to clinical diagnostic guidelines lowest in females aged <65 years. Only 40% (89/221 of cases in this guideline sub-cohort [females aged >65 years]) would have been a UTI, according to TARGET criteria, following a medical record audit.

Conclusion: UTI symptom management by clinicians is suboptimal; the presence or absence of symptoms is often insufficiently recorded in medical records. Additionally, suboptimal adherence to guidelines concerning urinalysis and microbiological investigation is common. Known increased clinical risks for males may be compounded by their more limited knowledge of (self)-managing UTI and their comparatively late presentation.

Keywords: UTI; antibacterial agents; antibiotics; clinical guideline; health confidence; self-management; urinary tract infections.