URINALYSIS 200,000 200 200 150,000 150 100,000 150 50,000 100 0 0 2018-19 50 2019-20 Total cases 2020-21 2021-22 Cases involving a patient aged 70+ 0


Fig 1. Finished Admission Episodes (FAEs) with UTI as a Primary Diagnosis (2018/19 to 2022/23). Year-by-year breakdown of the hospital admissions (in the form of FAEs) over the past 5 years, totalling over 800,000 admissions. Data taken from NHS England’s The National Archives.


different pathogens with different resistance profiles. Using a non-specific test may lead to the overprescription of broad-spectrum antibiotics in cases where a more 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 admissions 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 statistics (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 800,000 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. Rising levels of AMR in urinary pathogens is also a growing concern. Approximately 25% of urine samples


50


in the first half of 2023 contained bacteria resistant to a common antibiotic.8


2022-23 100


trends, with the aim of transitioning from a reactive healthcare model to a preventative one. It is critical though that information on innovative technology and methodologies is dissipated to healthcare professionals throughout all care levels. This will ensure that all tiers of the healthcare system are aware of what solutions exist and how they will benefit their workflows.


50


Some schemes have already been put into place to help lessen the burden of infections on primary care. One example is the Pharmacy First scheme, part of which allows women aged between 16 and 64 to access antibiotics for uncomplicated UTIs over the counter, following consultation with a participating pharmacist, as this completely removes diagnostics from the process with no requirement for a sample to be provided. While there are assurances that antibiotics would only be prescribed when ‘clinically appropriate’,11


it is difficult to see how In 2023, there were 66,730


recorded serious antibiotic-resistant infections in the UK, a rise of over 4,400 infections (7%) compared to 20196, with 65% of bloodstream infections involving Escherichia coli,6


the most


common causative pathogen of UTIs. A combination of the rising hospital admission numbers and the increasing resistance profile of E. coli urosepsis (as a result of bacteraemia) continues to intensify as a serious issue. Urosepsis was the topic of a previous Pathology in Practice article back in 2014 (which also discussed Mast Group’s previous urinalysis solution, the Mast Uri System). This article highlighted the value of retrieving antibiotic sensitivity results promptly to aid in prescribing narrow- spectrum antibiotics, decreasing the use of unnecessary antibiotics,9


and shows


that despite a decade of innovation, the risk of urosepsis remains a real threat.


Solutions


Published in July 2025, the ‘10 Year Health Plan for England: fit for the future’ stated that science and technology is being realigned as a primary focus for the NHS. The plan remarked on how the NHS is currently “behind the technological curve” and that prioritising it will be key to bringing “cutting-edge care to all patients”.10


This ambitious


plan discussed advancements in technology at every level of patient care, from pre-primary care in the form of wearables, to advancements in testing and result analysis at secondary care via new robotics and AI models. This will culminate in feeding back larger amounts of accurate data to help track


removing clinical diagnosis will aid antibiotic stewardship. Unsuccessful treatment plans have already been noted following this scheme, with patients presenting to primary care again following unsuccessful treatment.


The availability of innovative, high-


throughput diagnostic equipment will likely be the most appropriate strategy for the improvement of diagnosis and treatment of UTIs. Providing targeted treatment more rapidly is the key. This will reduce the chance of the development of a severe infection, resulting in a decrease in emergency admissions and curbing the misuse of broad-spectrum antibiotics. This should also help to flatten the curve of AMR, adhering to last year’s release of the UK Government’s new 5-year AMR action plan,12


where


the reduction in unnecessary prescribing and overprescribing of broad-spectrum antimicrobials is a key target.


Introducing the Mast Uri Connect


The Mast Uri Connect, an innovation of the popular Mast Uri System, aims to help clinical diagnostic laboratories reduce the pressure of UTI analysis. The high-throughput system provides direct, phenotypic urinalysis, decreasing turnaround time and ensuring full sample traceability. One of the new features on the system is the implementation of expert reading rules, that are aligned to current EUCAST breakpoint guidelines.13 This aims to help guide the user to a clinically relevant result, by flagging non-relevant sensitivities with the goal of championing antibiotic stewardship. One of the main benefits of the system is the fact that the testing is completed


AUGUST 2025 WWW.PATHOLOGYINPRACTICE.COM


Finished admission episodes


184,794 102,426


179,785 97,411


135,594 72,938


152,695 81,624


147,285 74,934


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