PM.12 The Management of Pregnant Women Attending Triage with Suspected Urinary Tract Infection (UTI)

Abstract

Aims This audit and re-audit was undertaken to ascertain whether women presenting to Triage, with symptoms suggestive of possible UTI, are being appropriately assessed/treated. Methods The Admission Proforma of all women attending Triage with lower abdominal pain with no clear cause, but where UTI was considered, was reviewed against agreed standards. Data was collected prospectively for a period of 2 and 3 weeks respectively. In each audit notes from 50 women were reviewed. Results In the initial audit 86% (43/50) had urine dipped but only 5% (2/43) of these showed nitrites (1 had confirmed UTI); 32% (16/50) were treated with antibiotics, 75% (12/16) of these had MSSU sent, but only 2 had confirmed UTI. In the re-audit 42% (21/50) of patients had an MSSU - 75% (6/8) of those prescribed antibiotics. Urine dipstick was performed in 94% (48/50) of all cases - 88% (7/8) of those treated. No nitrites were identified or UTI confirmed by culture. Conclusions Pregnancy increases the risk for UTIs and failure to treat has serious maternal/neonatal consequences, not least preterm delivery. Nevertheless a diagnosis of UTI is too frequently made; often without strong evidence, and women are being overtreated. Antibiotic resistance is an increasing problem; unnecessary prescriptions must be avoided. All women presenting with abdominal pain should have their urine dipped. Audit confirms that leucocytes and/or proteinuria are not indicative of infection; even nitrites may not be diagnostic. If positive for nitrites, MSSU must be sent and urgent microscopy could be considered, ahead of prescribing antibiotics.