#38: How ILDP Assists Regarding UTI - Diagnosis and Treatment

 Antibiotic stewardship is the effort to measure and improve how antibiotics are prescribed by clinicians and used by patients.  Providers who are top antibiotic stewards have a multi-faceted approach.  They work continuously to stay informed of the etiology of diseases and they continuously review the literature regarding use of antibiotics for specific pathogens.  Additionally, and one of the most important in my opinion, they educate their patients on appropriate use of the prescribed antibiotic and then they, or their staff, follow up with the patient during the course of treatment and after.  They also make use of the most accurate and fastest type of diagnostic testing such as PCR testing.

When to order a PCR test is also part of good stewardship to prevent unnecessary antibiotic use.  Focusing on urinary tract infections in this article, patients MUST have signs/symptoms of a UTI to order PCR testing.  Specifically fever, frequency of urination, urgency, dysuria, costovertebral or suprapubic pain, etc.  A urinalysis is not made to be a screen for a UTI infection alone.  Everything on the urinalysis is non-specific.  Okay, I already hear the gnashing of teeth and the “Yeah, but nitrites were present on the UA”.  Nitrites in the urine do suggest the presence of bacteria that have reduced nitrates to nitrites, however urethral, rectal and vaginal contaminants can cause bacteria to be present and thus produce nitrites on a UA.  Furthermore, hematuria, proteinuria, and bacteriuria found on a UA without symptoms, are not sensitive or specific enough to diagnosis a UTI. 

Recent studies show E. Coli is still responsible for the majority of UTIs, with Klebsiella pneumonia, Pseudomonas aeruginosa and Proteus mirabilis following closely behind.  Interestingly Proteus and Providencia caused more UTIs in elderly men than E. Coli.  With the discovery of a new drug resistant gene NDM-1 in E. Coli and Klebsiella, the practice of antibiotic stewardship becomes more critical.  Irrational use of antibiotics is still conducted in many parts of the world and perhaps in certain regions our own country, enabling the continued growth of more drug resistant pathogens.  In one study, E. Coli was resistant against ampicillin (92%), cotrimoxazole (80%), ciprofloxacin (62%), nitrofurantoin (47%) and amikacin (4%).  Patients who have drug resistant pathogens don’t require a history of overuse of antibiotics as the reason for acquiring them.  Environments such as nursing homes are known for the spread of these type of pathogens. 

The cat is out of the bag so to speak in regard to rampant antibiotic usage.  It is our job as a lab to assist the provider to make the appropriate decision regarding the medications they prescribe their patients.  Our  testing for drug resistance markers enables us to do this and allows us to contribute to our community antibiotic stewardship.  Please hug on your elderly family members.  As always we thank you for your business.

Lance Benedict

President/CEO Industry Lab Diagnostic Partners