Abstract
Urinary tract infections (UTIs) are associated with negative pregnancy outcomes and are treated with antibiotics. Although beneficial, antibiotic use causes antimicrobial resistance (AMR), and therefore their use needs to be carefully balanced. Antimicrobial guidelines are developed to facilitate appropriate prescribing of antibiotics. This study assessed antibiotic prescribing for UTIs in pregnancy against the National Institute for Health and Care Excellence (NICE) guideline NG109. Fifty antibiotic prescribing records dated from 1st October 2018 to 1st July 2019 were identified from three London-based GP practices. The results show that a mid-stream sample of urine, which is important for the review and tailoring of antibiotic treatment, was collected in 77.6% of cases. Prescribing the first-line antibiotic is important for adequate treatment and good antimicrobial stewardship and results show that 44% of prescriptions were for the first-choice antibiotic. Most prescriptions (56%) were for a second-line or non-recommended antibiotic. Providing self-care advice is key to empowering pregnant women in managing their own health but only 16% of records documented provision of self-care advice. This study highlights important areas of concern in the management of UTIs in pregnancy. However, due to the retrospective design, future work is needed to evaluate the role of AMR in the prescriber’s treatment decision-making process.
Highlights
Urinary tract infections (UTIs) are caused by bacteria that colonise and infect the urinary tract.The infection commonly causes symptoms such as increased frequency of urination and burning pain when passing urine [1]
UTIs are classified as asymptomatic bacteriuria, acute cystitis or pyelonephritis [5]
The National Institute for Health and Care Excellence (NICE) guideline recommends the collection of a MSSU sample to test the susceptibility of the causative bacteria prior to the use of antibiotics
Summary
Urinary tract infections (UTIs) are caused by bacteria that colonise and infect the urinary tract. The infection commonly causes symptoms such as increased frequency of urination and burning pain when passing urine [1]. More severe symptoms can include nausea, vomiting, chills and a high fever [2]. Bacteria that cause a UTI are usually commensal within the body and normally transfer to the urinary tract from the gut [3]. A shorter urethra in women makes it easier for bacteria from the gut to pass into the urinary tract and cause an infection. UTIs are classified as asymptomatic bacteriuria (presence of bacteria in the urine without symptoms), acute cystitis (affecting the bladder) or pyelonephritis (affecting the kidneys) [5]
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