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.

Urinary tract infections and antibiotic use in pregnancy - qualitative analysis of online forum content

“…Excessive and unnecessary use of antibiotics is strongly associated with a rise in antimicrobial resistance (AMR) which is the ability of bacteria to survive in spite of antibiotic treatment leading to life threatening infections [9]. There is evidence from the UK and internationally which suggests that antibiotics to treat UTIs are overprescribed in pregnant women [10, 11]. Although AMR is a global public health threat to everyone, in pregnancy it can be particularly concerning due to the risk of resistant bacteria passing on to the neonate during birth which can be a vulnerable stage of life with regards to contracting infections.…”

Antibiotic Prescribing in Primary Care for Urinary Tract Infections (UTIs) in Pregnancy: An Audit Study

“…The inclusion criteria were women who were pregnant and had been prescribed an antibiotic indicated for a UTI. A sample size of 50 sequential patient records was set as the target sample size; the rationale for this is that it is in line with a similar audit conducted previously [ 15 ]. Medical notes were assessed to collect data on antibiotic prescribing, and determine the appropriateness of the prescriptions according to the audit standards which were adapted from the NICE antimicrobial guidelines for lower UTI [ 19 ].…”

“…Resistant infections can be difficult to treat and are associated with significant morbidity and mortality [ 14 ]. There is evidence to suggest that antibiotics to treat UTIs are overused in pregnant women [ 15 , 16 ], which can cause a rise in resistant UTIs. Resistant UTIs can be particularly concerning in pregnancy [ 17 ] because although they can be a challenge to treat in general, ensuring the combined safety of the woman and foetus adds further difficulty in pregnancy.…”