Abstract
BackgroundUrinary 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.AimTo 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 & settingSurvey and clinical audit in 12 general practices in England.MethodPatients (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.ResultsA 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, Χ2test). Analgesic use was 50% for females aged <65 years and 41% for females aged >65 years compared with 36% for males (P= 0.036, Χ2test). 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, Χ2test). 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.ConclusionUTI 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.
Publisher
Royal College of General Practitioners