Recurrent Urinary Tract Infections: old story, new frontiers

Urinary tract infections (UTIs) are common and frequently recur. Successful management is challenging, with UTIs responsible for 14% of community antibiotic prescriptions. Improving the management of recurrent UTIs is a national priority carrying major implications for antimicrobial stewardship.

Methods

We have introduced a multi-specialty clinic with a personalized approach to antimicrobial prescribing. Together a consultant medical microbiologist and a consultant urologist assess each patient’s pre-disposing risk factors and symptomatic burden. Anatomical and functional urological factors, and issues such as poor sample quality and lifestyle are investigated. Choice of antimicrobial agent, as well as the mode and frequency of administration, is made in accordance with patient preferences, resistance patterns, and risk factors.

Primary and secondary care data was collected for the year preceding and the year following initial clinic attendance. The impact of attendance on acute admissions, antibiotic prescribing, diagnostics utilization, and primary care workload was assessed.

We assessed the impact of 36 clinic attendances. We noted a 91% reduction in acute admissions, a 73% drop in UTI related primary care attendances, a 57% fall in antibiotic prescriptions, and a 61% reduction in the number of MSUs sent. Qualitative data also indicates a substantial impact on patient quality of life.

To our knowledge we are the first center to utilize a multi-speciality recurrent UTI clinic to personalize antimicrobial and surgical therapy in tandem. Improvement in clinical outcomes is matched by reduced workload. Further study will assess long-term impact and will support regional adoption of this stratagem.