Urinary tract infections are noted as the most common bacterial infections overall both for men and women in all patient care settings, while disproportionately affecting women and older adults.¹ Patients presenting with UTIs account for a signification proportion of primary care appointments, and consequently, urinalysis testing in clinical laboratories presents a considerable time and resource sink.²

As a result of such a high prevalence, it is no surprise that there is a remarkably high use of antibiotics against UTIs. In England, at a primary care level, 18% of all antibiotics prescribed were to treat lower or recurrent UTIs.³ A study of 587 general practices showed that between 2000 and 2015, prescriptions of antibiotics for UTIs were the third most numerous, only behind prescriptions for upper and lower respiratory tract infections.4 It also presented that UTIs had the highest prescription rate, coming in at 89.4%. Such a high prescription rate indicates UTI treatment should be one of the key targets for confronting the issue of AMR.

At a primary care level, it can be safely assumed that, in most cases, antibiotic prescriptions are provided in line with correct operating procedures and that resulting treatments are, therefore, applied correctly. Primary care is often limited by the point-of-care tests (POCT) available, yet they provide a fantastic service with the tools they have at their disposal.

However, current UTI POCT involves using dipstick tests that, while being a quick and accessible test, are not always accurate. The test strips identify leucocyte esterase, nitrite levels and blood, which provide little to no information on the pathogenic cause of the infection.⁵ It is important to note that no two UTIs are the same, with each infection containing different pathogens with different resistance profiles. Using a non-specific test may lead to the over prescription of broad-spectrum antibiotics in cases where a mor patient-targeted approach was required. As levels of resistance to broad-spectrum antibiotics rise, they will become less effective, increasing the likelihood of patients presenting back to primary care following unsuccessful treatment. There are also instances where patients with recurring symptoms, who also produce negative dipstick test results, may also be prescribed non-specific antibiotics - potentially unnecessarily - theoretically contributing to the growing burden of AMR.

At a secondary/tertiary care level, the latest data (2022-2023) presented that 18% of the 1.9 million emergency admission for bacterial infection and/or sepsis in England (~335,000 cases) had a UTI clinical code attributed to the patient during their admission.³

Additionally, latest statistic (2018-2023) estimated that UTI infections as a primary diagnosis accounted for 800,000 hospital admissions.⁶ Data also show that, in this same period, over 50% of the 800,00 hospital admissions were related to patients aged 70 and over, with an average hospital stay of 17 days.³ (See fig 1.) UTIs are also the second biggest contributor to hospital-acquired infections (HAI).7 The vulnerability of the admittees (as a result of their age), in addition to the likelihood of comorbidities, heightens the risk of patients contracting HAI-UTI, highlighting the need for clinical laboratories to have access to technology that provides accurate results promptly.

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