Urinary tract infections (UTIs) are amongst the most common bacterial infections. In England, one fifth of all antibiotics prescribed are for treating UTIs and prescriptions for these antibiotics in primary care cost nearly £50 million per year.
However, UTIs are becoming harder to treat due to antimicrobial resistance - a quarter of urine samples analysed in the first six months of 2023 had bacteria resistant to a common type of antibiotic used in treatment.
Older people are more prone to UTIs and can become seriously unwell. Nearly 60% of those hospitalised for UTI over the past five years were over the age of 65.
Care home residents are commonly diagnosed and treated for UTI. However, there are several challenges that make it particularly difficult to accurately diagnose UTIs in this population, including lack of clear symptoms and memory loss. In addition, many older people living in care homes have bacteria in their urine even when they are well (not requiring treatment) – so finding bacteria in a urine sample does not necessarily mean they have a UTI.
Methods to accurately diagnose UTIs are crucial to ensure appropriate use of antibiotics and protect the effectiveness of existing treatments. Healthcare professionals need to know which care home residents truly have a UTI so they can prescribe antibiotics and avoid risking serious consequences. However, it is also important to avoid prescribing antibiotics in those who do not have a UTI to prevent antibiotic resistance and side effects. Unfortunately, existing tests are not very helpful in accurately and/or rapidly diagnosing UTI for older adults in care homes.
To tackle this challenge, Dr Abigail Moore, a GP and a DPhil student at Oxford’s Department of Primary Care Health Sciences has carried out feasibility cohort study across eight care homes in England to explore new methods to diagnose UTIs in care home residents. This included looking at new point of care tests for UTIs which may result in faster treatment decisions, potentially improving patient outcomes.
As a GP I can experience diagnostic uncertainty around UTI diagnosis in care homes and I wanted to explore how we can improve that. However, care homes are still a relatively naïve environment when it comes to healthcare research. The aim of this project was to see whether this study would be possible on a larger scale in more care homes in the future. We wanted to know whether it was acceptable for care home residents and staff to be involved.
81 care home residents were recruited to the year-long study conducted in partnership with the University of Southampton, University of Bristol and Oxford’s Department of Primary Care Health Care. Participants provided urine samples when they joined the study, and additional samples were given if they experienced a possible UTI during their follow up. Overall, 23% participants experienced at least one possible UTI whilst in the study- highlighting how common UTIs are in care homes.
Data analysis is in its early phase, but the research is already proving to have been feasible and acceptable in the care home setting.
Looking ahead, I hope to carry out a much larger study building on the findings from my DPhil. Creating better UTI tests relies on strong partnerships between researchers, clinicians like GPs and geriatricians, and with care home staff and residents’ families. It’s vital that we understand the problem from their perspective if we want to find solutions that truly work in real-world settings.
