119DIAGNOSIS AND MANAGEMENT OF URINARY TRACT INFECTION IN ADULTS: A MULTIDISCIPLINARY APPROACH TO EFFECT A CULTURE CHANGE

Abstract

Topic: Urinary tract infections (UTIs) are caused by the presence and multiplication of microorganisms within the urinary tract: this definition covers a spectrum of conditions from asymptomatic bacteriuria to symptomatic UTI to urosepsis. Asymptomatic bacteriuria represents colonisation rather than infection; thus, treatment is not indicated. Inappropriate treatment of asymptomatic bacteriuria carries risk of adverse drug effects from antimicrobial treatment and promotes the evolution of resistant organisms. We sought to improve diagnosis and management of symptomatic UTIs in patients attending Chesterfield Royal Hospital. Method: A prospective audit of hospitalised inpatients with a diagnosis of UTI (excluding catheterised and septic patients) was performed based upon the NICE UTI Quality Standards. 30.7% of our initial group did not have any documented symptoms of UTI and 30.7% of patients had only one symptom. The most common symptom documented was dysuria. According to the pre-test probability of urine dipstick, 69% of dipstick tests were performed inappropriately. We undertook a multi-disciplinary approach to address these issues, involving geriatricians, pharmacy, microbiology, GPs and the infection control nurses. The trust guideline for UTI diagnosis was updated with links from the antibiotic guideline page. Poster and twitter campaigns were introduced to highlight the importance of correct diagnosis to healthcare professionals. Urine culture sensitivity results were withheld in the absence of clinical justification. Results: On repeat audit 3 months later, 16% of patients were asymptomatic and 40.1% of patients had one documented symptom. 80% of patients had undergone a urine dipstick, only 50% of these now appeared inappropriate. Antibiotic choice was consistent with hospital policy throughout, but the duration of antibiotic treatment reduced from 7.18 days to 6.18 days. A review of notes suggested that the latter was due to diagnoses being questioned. Further PDSA cycles are planned. This project highlights the importance of multidisciplinary approach to effecting change.