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GPs should not perform urine dipstick in over 65s with suspected UTI, says PHE

Public Health England has published new guidance advising GPs they should stop performing urine dipsticks in patients over 65 years old with a suspected UTI. 

The new guidance comes as part of a quick reference guide for primary care that is currently under consultation and aims to ‘minimise the emergence of antibiotic resistance in the community’.

GPs welcomed the guidance, saying that the recommendation will cut the number of urine specimens taken ‘without good reason’ that they receive from care and nursing homes.

The guide includes diagnosis flowcharts for patients under and over 65 years old, including children under 16 years.

For those over 65 with a suspected UTI, PHE has said: ‘Do not perform urine dipstick…up to half of older adults will have bacteria present in the bladder/urine (asymptomatic bacteriuria) and positive dipstick without an infection. This is not harmful and does not require treatment with antibiotics.’

The draft guidance, which outlined the studies used to create the recommendations, added that although ‘dipsticks can moderately improve diagnostic precision, they are poor at ruling out infection’.

BMA GP Committee clinical and prescribing policy lead Dr Andrew Green said: ‘We would fully support this, GPs are often inundated with urine specimens from care and nursing homes taken without good reason, and the dipping of a urine specimen should be looked upon as in investigation with potential harms, and only performed in specific circumstances.

‘Also, every elderly patient discharged from hospital seems to have a UTI diagnosis, they don't, they usually have asymptomatic carriage.’

PHE’s head of primary care unit Professor Cliodna McNulty explained: ‘Our draft guidance for diagnosing urinary tract infections (UTIs) aims to provide a simple toolkit for GPs to effectively treat UTIs, while minimising antibiotic resistance in the community...

‘Alongside limiting the emergence of antibiotic resistance, these guidelines may ease laboratory workload, with possible positive financial implications for both laboratories and primary care commissioners.’

The consultation on the draft guidelines will be open for feedback until 30 May 2018.

These recommendations come after NICE urged GPs earlier this month to counsel patients on effective self-care and consider delayed prescriptions for UTIs in an effort to reduce the risk of antibiotic resistance.

It also forms part of a larger push to reduce the number of antibiotic prescriptions, which saw nearly 9,000 GPs receive personalised letters telling them that they are overprescribing antibiotics.

Readers' comments (11)

  • David Banner

    Indiscriminate dipsticking is indeed a curse, but please leave the GP to dipstick/MSU if clinically appropriate.
    Asymptomatic UTIs (leading to nephritis, urosepsis and death) are not rare in the elderly, and early diagnosis/treatment is essential.
    The rush to reduce antibiotic prescribing must not compromise patient (and GP) safety.

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  • Stange how nearly every off elderly patient admitted to hospital are diagnosed with some sort urosepsis and discharged a quickly as possible are they saying this is also acceptable as a lot of these seem not to be done with bacteriology advice only on expediency.I will not change practice as the first one do die of urosepsis will inevitable result in a serious complaint and this lot will not be there to defend you.We only need to look at the Dr BG case to see how expendable we are.Also even if there is no complaint the inevitable hospital doc say why didn't the GP prescribe for the obvious infection they are useless comment to the patient will materialise.Havnt we all seen that with the viral illness we see is kid which has been diagnosed as a bacterial infection after serum rhubarb, blood gasses a lumber punter X-rays etc when they turn up at A&E and are admitted for observation.The days of Americanised defensive medicine are upon us friends'nd there is no shutting pandoras box of s**t medicine once its opened.WE reap what we sow.

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  • Took Early Retirement

    TOTL- Agree 101%

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  • Curb Your Enthusiasm

    totally agree also. Lost count of how many times been to NHs to be told the "urine dip was positive for everything doctor"., when the real reason they "look pale...didnt eat breakfast today... seemed tired" is that they are 95 years old and not that they have a bacterial UTI. I feel most GPs will be slow on the uptake of this however

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  • how will the OOH service cope if they can"t diagnose "UTI" as cause for everything?

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  • In elderly females the dipstick is always positive. This is great as a diagnosis is given and 3 days of antibiotics issued.
    With younger patients you need to use the special reagent strips (the ones where you left the lid off for 24 hours) so that you always find leucocytes. With a flourish you can show them the pos leucs and send them off happy with a diagnosis and script.

    All part of the GP survival guide

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  • "how will the OOH service cope if they can"t diagnose "UTI" as cause for everything?"

    Au contraire--the diagnosis of suspected UTI can now be given without the worry of finding leucocytes

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  • I have enough insight to see that my comments are increasingly jaundiced and cynical. I am banning myself from posting any Pulse comments for one month.
    See you all in July


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  • AlanAlmond

    Saw an old lady this evening. She ‘wasn’t right’. I could find nothing wrong with her. Her daughter was concerned she had a UTI and informed me the last time she was admitted to hospital with delirium she was diagnosed with a UTI and quickly improved with antibiotics. They’d brought a urine sample with them and wanted me to dip it. It was/is Friday evening and the weekend beckons. What did I do?
    (and it didn’t involve having to dip her urine)

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  • The best advice in so many situations is “don’t just do something, sit there”. Mum’s “not right?”. Try a cup of tea and a chat and see how she is tomorrow. Mrs Jones the 97 year old demented NH patient is “chesty?”. Sit her up properly and supervise her meals and fluid intake then if no better call us. And arrange a proper pathway for acopia that doesn’t involve dumping in ED at 4am in a hospital with no beds.

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