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This week's HPA conference heard plans for an overhaul of UTI monitoring and a GP role in terror response ­ by Daniel Cressey

The Health Protection Agency is demanding an overhaul of GPs' monitoring of urinary tract infections to combat a surge in cases of resistant E. coli.

A new HPA report warned that 'widespread emergence' of a new strain of ESBL-E. coli was causing a 'substantially different and larger ESBL problem than existed previously'.

The HPA called for GPs in areas with high rates of ESBL-E. coli to submit all their UTI samples for testing.

Dr Georgia Duckworth, head of the health care associated and antimicrobial resistance department at the HPA's centre for infections, said: 'GP practice varies ­ some send virtually every specimen and others will only send a specimen when a patient hasn't responded to antibiotics. It's about trying to standardise this.'

Professor David Livermore, director of the antimicrobial resistance monitoring and reference laboratory at the centre, told Pulse: 'We want all urines from treatment failures. In regions where [E. coli] are becoming prevalent maybe all urines would be prudent.'

ESBL-E. coli which produce extended spectrum beta lactamase enzymes are a growing problem.

Resistance to two cephalosporins ­ cefotax-ime and ceftazidime ­ increas-ed from 1.8 per cent of E. coli in 2001 to almost 6 per cent in 2004 in England, Wales and Northern Ireland.

The HPA said GPs needed regular updates of local resistance patterns and warnings of rises in rates of ESBL-E. coli ­ a system used in a recent outbreak in Shropshire that killed 10 people.

GPs in Shropshire said the updates had worked well.

Dr David Morris, a GP in Shrewsbury, said the advice from consultant microbiologists had been 'clear and very welcome' following identification of a 'highly resistant strain of E. coli responsible for UTIs'.

The HPA also expressed concern at plans to make trimethoprim available over the counter for UTIs, warning the move could bring delays

in analysis and GP involvement.

Professor Livermore said: 'This has to be a concern. If people can get an antibiotic OTC then microbiology is not going to be done.'

The HPA made further recommendations including more stringent treatment guidelines (see box), although it said some were outside its remit and required consideration by the 'wider NHS'.

HPA recommendations

·GPs informed on resistant E. coli in community

·Guidelines on specimens to send to laboratories

·Serious infections in community to be reported to local consultant in communicable disease control

·More formal treatment guidelines to replace ad hoc responses in outbreak areas

·Development of sentinel network to investigate community UTI samples

·Further action to ensure labs use methods that will identify ESBL producers

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