URINALYSIS
The burden of urinary tract infections:
challenges and solutions
With urinary tract infections being both a burden on the health system and a contributor to antimicrobial resistance, Jonathan Shaw says that advanced diagnostics can play a key role.
Urinary tract infections (UTIs) constitute some of the most common bacterial infections treated in the UK. While often perceived as minor and transient, UTIs pose a significant challenge to public health, with rising levels of antimicrobial resistance (AMR) adding further complexity to an already demanding clinical landscape. The burden of UTIs is felt at every level of the UK’s healthcare system, from general practice to clinical laboratories.
This begs the question, what can be done to help improve the situation? The dominance of UTIs as a clinical target will likely persist, and in a clinical landscape looking to strengthen its antibiotic stewardship, solutions that are cost- effective, accurate and that have a quick turnaround time (TAT) need to be widely available.
This short article will investigate
this burden, focusing on: the statistics surrounding UTI analysis; the challenges that our health system faces; and the solutions that could be used to help lessen the burden and improve patient outcomes.
Challenges
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 significant 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
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.
WWW.PATHOLOGYINPRACTICE.COM AUGUST 2025 49
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