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UTI Audit. Alice Lawton GP ST3. My Audit. Patients aged >65yrs Treated for suspected/proven UTI in January 2011 Looked at choice of antibiotic, treatment length and whether MSU sent. Results. 19 patients 13F 6M Average age 78. Choice of Antibiotic. Treatment Duration. Local Guidelines.

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uti audit

UTI Audit

Alice Lawton

GP ST3

my audit
My Audit
  • Patients aged >65yrs
  • Treated for suspected/proven UTI in January 2011
  • Looked at choice of antibiotic, treatment length and whether MSU sent
results
Results
  • 19 patients
  • 13F 6M
  • Average age 78
local guidelines
Local Guidelines
  • Trimethoprim 200mg BD

OR

  • Nitrofurantoin 50mg QDS

For 7 days

our practice
Our Practice
  • High use of cefalexin
  • Against guidelines
  • Broad spectrum antibiotics
    • Increased incidence C. Difficile
    • MRSA
    • Future resistant UTIs
local guidelines9
Local Guidelines
  • Send MSUs for all >65
  • Also all men, pregnant women, children, recurrent infections and failure of treatment
quick reminder other uti
Quick Reminder Other UTI
  • Uncomplicated UTI<65yr
    • Trimethoprim 200mg BD or Nitrofurantoin 50mg QDS - 3 days
  • Men/recurrence/failure -
    • as per >65yrs
  • Pregnant women
    • Cefalexin 500mg BD or Amoxicillin 500mg TDS - 7 days
  • Children
    • Trimethoprim/nitrofurantoin/cefalexin - dose as per child - 7 days
catheterised patients
Catheterised Patients
  • Routine CSU not indicated
  • Do not use CSU/dipstick to diagnose
  • Clinical basis - sx UTI
  • Send CSU if sx
  • Change long term catheter before treatment
  • Choose abx from CSU if poss (trimethoprim/nitrofurantoin 7D if not)
  • Take into account prev CSU results
  • Review antibiotic
  • Antibiotic prophylaxis not recommended
acute pyelonephritis
Acute Pyelonephritis
  • Send MSU
  • Co-amoxiclav 625mg TDS

OR

  • Ciprofloxacin 500mg BD

OR

  • Cefalexin 500mg TDS (if pregnant)

14 days

re audit results
Re-audit results
  • Correct antibiotic (ie trimethoprim/nitrofurantoin)
    • 76.5% (previously 42%)
  • Correct treatment duration of 7 days
    • 84.6% (prev. 78.9%)
  • MSU sent?
    • 84.6% (prev. 52.6%)
  • Note of the MC&S sent none were resistant to trimethoprim which was cited as a reason for prescribing cefalexin by the clinicians
conclusion
Conclusion
  • Try and avoid broad spectrum abx
  • Trimethoprim and nitrofurantoin are first line in all UTI treatment (apart from pregnant women)
  • Duration 7 days in all but uncomplicated UTIs in women <65yr
  • Send MSU in all but uncomplicated UTIs in women <65yr