Improvements needed in the UTI diagnosis process

Improvements needed in the UTI diagnosis process
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According to a new quality standard published by NICE, the UTI diagnosis process for women will improve significantly in 2023.

Urinary tract infections (UTIs) affect your urinary tract, including the bladder, urethra or kidneys. A UTI diagnosis can be made when an individual has symptoms such as burning when peeing, pee that looks cloudy, needing to pee more often and lower tummy pain.

A diagnosis of a UTI in women under 65 can be made with increased certainty when two or more key urinary symptoms are present, despite no single symptom or combination of symptoms being completely reliable. Women with two or more key symptoms should not require a dipstick test.

Improving the quality standard for the UTI diagnosis process

The new quality standard includes five statements and replaces an earlier quality standard published in 2015. They are:

  • Women aged under 65 years are diagnosed with a UTI if they have two or more key urinary symptoms and no other excluding causes or warning signs.
  • Adults with indwelling urinary catheters do not have dipstick testing to diagnose UTIs.
  • Men and non-pregnant women are not prescribed antibiotics to treat asymptomatic bacteriuria.
  • Non-pregnant women with an uncomplicated lower UTI have been prescribed a three day course of antibiotics, and men and pregnant women with an uncomplicated lower UTI have been prescribed a seven day course of antibiotics.
  • Men with a recurrent UTI and women with a recurrent lower UTI where the cause is unknown or a recurrent upper UTI are referred for specialist advice.

Women are more likely to experience a UTI

Women have a shorter urethra than men, meaning bacteria are more likely to reach the bladder or kidneys and cause an infection. The management of urinary tract infections in trans people will need to account for any gender reassignment surgery and whether there has been a structural alteration of the person’s urethra.

Dr Paul Chrisp, director of the Centre for Guidelines at NICE, said: “UTIs are a common occurrence, but they can cause people a great amount of discomfort and pain. For people with recurrent UTIs, this can lead to a reduction in their quality of life.

“This quality standard sets out useful and usable guidance for health professionals to improve the diagnosis and management of UTIs in both women and men while also setting a clear treatment pathway for people with a recurrent UTI who are at higher risk of complications.

“The standard will also help ensure that people are not misdiagnosed. By setting out clear methods for the diagnosis of UTIs, it will help limit the prescription of unnecessary antibiotics which may increase anti-microbial resistance to certain treatments.”

Furthermore, the new quality standard also said the prevalence and frequency of UTIs should be measured accordingly:

  • The number of episodes of a suspected UTI should be recorded in the patient’s records.
  • Recurrent UTIs should be recorded in the patient’s records.



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