Sunday , July 3 2022

Better tests for urinary tract infections are needed



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Doctors urgently need a quick and accurate test to diagnose urinary tract infections (STIs) to reduce antibiotic over-prescription, according to health researchers.

Dr. Mar Pudjades Rodriguez of the University of Leeds says that without access to a reliable test, doctors run the risk of prescribing unnecessary antibiotic treatments that increase the risk of antibacterial resistance.

Ongoing urine tests for a bedside urine screening sample for infection are inaccurate and laboratory testing is slow. The NHS guidelines currently recommend laboratory testing in specific patient groups, such as children and elderly men.

UTI is a relatively common problem, but in some cases complications can occur when the infection spreads to cause kidney infection or sepsis.

A new study from the University of Leeds looks at nearly 500,000 cases of STIs in patients treated in England between 2011 and 2015 from records made by 390 GPs.

Fewer than one in five patients treated for UTI has a laboratory urine test to diagnose their problem. Tests have not been performed more frequently in men than women or in those returning for second treatment as their symptoms persist, contrary to NHS guidelines.

Therefore, existing laboratory tests for UTI have little effect on antibiotic prescribing.

The study also found that every five patients who should return to their doctors for a second round of treatment for UTI are prescribed the same antibiotic that was given for the first time, which is not a recommended practice and may increase the chance development of resistance.

As a result, thousands of people in England have been given recipes that have little chance of cure for their infection and may increase the risk of developing antibiotic resistance.

Published today in the magazine EClinicalMedicine (The Lancet) study shows that doctors require more accurate and faster options for UTI testing and should consider different antibiotics if a first course of treatment fails.

The study was funded by the improvement of the UK National Health Service.

Lead researcher Dr. Mar Pugades Rodríguez of the Institute of Health Sciences at the University of Leeds said: “At the moment, doctors are limited in their ability when someone shows signs of UTI and urgently needs access to accurate rapid diagnosis tests.

"UTIs are one of the most common reasons why antibiotics are prescribed, so the potential contribution this can make to antibiotic resistance can be very important.

"In addition, many patients can make things worse by taking residual antibiotics that are prescribed and using them to treat other infections or by not completing the course of treatment."

Currently, doctors can use a laboratory test to diagnose UTI, but it takes about two to three days to provide results. The test is intended to ensure that the patient actually has a UTI and that the appropriate antibiotic is prescribed for his treatment.

However, only 17% of patients in the current study who were treated with antibiotics were tested.

Danger of repeated prescriptions

The NICE guidelines state that if antibiotics do not successfully cure infection and symptoms continue, patients should not be re-prescribed with the same antibiotic to reduce the likelihood of antibiotic resistance and treatment failure.

When people are treated for antibiotic infection, some of the friendly bacteria that usually live in the body develop antibiotic resistance. These bacteria may transmit resistance to other bacteria that may cause infections in the future, making these new infections more difficult to treat.

In their study, researchers looked at nearly 500,000 cases of PTI in patients in England treated between 2011 and 2015. The majority of patients were treated with antibiotics, and 17,000 (4%) of them required patients to be treated with antibiotics. returned to their doctor as their infection had not cleared up.

For these repeat visitors, a significant proportion were prescribed the same antibiotic that they were initially treated with only 80 percent correctly receiving a different antibiotic capable of dealing with their infection.

It is worrying that the rate at which male patients should return for second treatment for the same UTI increased by about 20% during the study period (from 5.2% in 2011 to 6.2% in 2015 ).

This increase in re-prescribing of antibiotics should be observed as it may be associated with an increase in antibiotic resistance.

Researchers also find that patients who have recently been prescribed antibiotics are more likely to need additional treatment to deal with UTI.

Patients who have been prescribed antibiotics in the last three to six months are 37% more likely to require a second treatment for their UTI than those who have not been given antibiotics in the last year.

Those who were prescribed antibiotics in the last one to three months were almost twice as likely to require second treatment. And those who were prescribed antibiotics last month were more than three times more likely to need a second treatment than those who had not been given antibiotics in the last year.

According to the researchers, all these figures suggest that antibiotic resistance was the cause of treatment failure.

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Notes to editors

For interview requests, please contact Simon Moore, Press Officer at Leeds University on 0113 34 38059 or [email protected]

The document published in the magazine EClinicalMedicine (The Lancet), entitled "Lower Urinary Tract Infections: Management, Results, and Risk Factors for Antibiotic Prescribing in Primary Care," and will be available online here: https://www.thelancet.com/journals/eclinm/ article / PIIS2589-5370 (19) 30120-8 / full text

University of Leeds

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