Antibiotics and urinary tract infections

Antibiotics, better tests, UTI: Guardian publishes Forte response

A rise in persistent UTIs could be linked to antibiotic crackdown appeared in The Guardian on Saturday 5th October. As usual, no-one mentioned accurate basic specimen collection, which can lead to unwarranted specimen quality variation, failed analysis and less-than-targeted prescribing. Giovanna Forte had something to say. Click here to read her published letter.

Peezy Midstream reduces unnecessary antibiotics

The Practising Midwife AMR in pregnancy feature

Unreliable urine screening in pregnancy can lead to the prescribing of antibiotics that may not be needed. Our feature on page 12 of The Practising Midwife outlines the dangers of unnecessary antibiotic use in pregnancy and how antimicrobial resistance can be triggered in the womb. Accurate urine collection is a powerful tool to take women and their unborn children off the frontline of AMR.

The Lancet: UTI Guidelines are not followed

The Lancet: Lower Urinary Tract Infections (LUTS): Management Outcomes and Risk Factors for Antibiotic Re-prescription in Primary Care .

This study (link here) states that implications of all the available evidence confirms that guidelines for investigation of UTI are not being followed, findings which chime with Forte Medical’s experience of UTI diagnosis. Simply, without an accurate urine specimen cultured to identify problem bacteria, GPs will continue to prescribe medicine to which bacteria are immune.

“Use of microbiological investigations current has little impact on prescribing. There is a need to consider recent antibiotic use to prevent re-prescription of the same antibiotic.”

Giovanna Forte, CEO of Forte Medical recently suffered a major kidney infection, borderline sepsis and (unplanned) hospital admission after her GP repeated a prescription of an antibiotic that had failed first-time.

We believe that a protocol for the investigation of urine will prevent mis-management of and unnecessary antibiotic prescribing and will continue its campaign for accuracy and prevention to prevail over cure.

National Institute of Health and Care Excellence logo

Dr Liam Farrell, Primary Care Advisor to Forte Medical

Forte Medical is delighted to welcome Dr Liam Farrell as Advisor to the company on Primary Care matters.

A UCD Graduate, Liam was a family doctor in Crossmaglen for 20 years and MacMillan Fellow in Palliative Care during the 1990s. His award-winning columns have been collected into an erudite, amusing and often touching book Are you the F**king Doctor? These appeared in a cross section of titles including British Medical Journal, the Lancet, Journal of General Practice and GP Magazine.

“Understanding what primary care needs are around the most common routine diagnostic process of urine collection and analysis is fundamental to our work,” said Giovanna Forte, CEO of Forte Medical. “Liam’s experience on the primary care front line gives us an idea of what GPs really have to deal with, how we can improve their lot and what difference our tech can make to them, their prescribing patterns and waiting lists. The right tone of voice in communicating these messages is essential and we’ll be looking to Liam to help us hit the right note. Having read his book, I can’t think of anyone better.”

National Institute of Health and Care Excellence logo

MedTech Innovation Briefing: Peezy Midstream

Five years ago we met with NICE to find out how to generate a MedTech Innovation Briefing paper. “More evidence,” they said. “Oh, and a cost savings model and Clinical Champions will help too.” With all that and more, we are proud to announce the NICE MedTech Innovation Briefing paper for Peezy Midstream.

Midwifery auditing urinalysis

Clinical antenatal evidence: 70% false-positive reduction

When NHS West Hertfordshire Patient Safety Midwife Sylvia Bone found a Peezy Midstream kit in a cupboard, she called us to ask if she could run a trial. Of course, we said yes. Read about her astounding results at professional midwifery educational exemplar platform All4Maternity

GIRFT Pathology: Peezy Midstream in pre-operative screening

Tom Lewis, Consultant Microbiologist at North Devon NHS Trust and Pathology Lead for the Department of Health’s Getting It Right First Time programme (GIRFT), today posted on the GIRFT Pathology blog his initial findings of improved microbiology screening of pre-operative urine specimens using Peezy Midstream. Read his full report here.

Existing clinical evidence supports the GIRFT findings and wider studies are already being set up or run by North Devon and other NHS Trusts.

Loyola Medical School Chicago publish Peezy Midstream clinical trial evidence

A clinical trial to ascertain reduced bacterial contamination in Peezy Midstream collected urine specimens has been published by the Loyola Chicago Stritch School of Medicine.

The Clinical Trial, a collaboration between Departments of Microbiology, Urology and Obstetrics and Gynaecology, concludes that Peezy Midstream delivers a much better ‘clean catch’ midstream urine specimen than either traditional methods or the use of an antibacterial wipe used before a patient provides the specimen.

A Cross-sectional Pilot Cohort Study Comparing Standard Urine Collection to the Peezy Midstream Device for Research Studies involving Women is published in the Journal of Female Pelvic Medicine and Reconstructive Surgery and available on Researchgate. Download the full study here.

The value of urinalysis

The value of urinalysis in antenatal settings

Informative article in The Practising Midwife by Editor and Senior Midwifery Lecturer at University of Central Lancashire, Anna Byrom, reviewing the evidence and practice around this important area of health in the ante-natal sector. Full article can be found in the March issue below on page eight

Comment: The Basic Diagnostic Failure That Affects 1 in 3 Women

Its time to reignite our NHS! Now our beloved health system has been blessed with new funding, we can furnish every hospital and GP practice with the latest digital technology and AI. We can burnish the reputations of our healthcare leaders because they have modernized patient care. 

It seems it is so much easier to spend new money, than it is to fix a failing system. Yet while this exciting digital revolution takes place, the Department of Health and NHS continue to fail 15m patients every year, whilst flushing £1.2bn of public funds down the loo. This is more than a shame; it’s a scandal.

There is one basic diagnostic process which is not as sexy as glittering new tech. It doesn’t excite our healthcare commentators. It will not invest our clinical leadership with shiny accolades that add kudos to reputation. It will not be covered by the media because it’s a waste product that no one really likes to talk about. Yet this waste product carries as much, if not more diagnostic clues to our health as its counterpart, blood. We need to talk about urine.

“If you don’t make the effort to collect the urine specimen properly, all the clever stuff you do later is pretty pointless. It’s a case of rubbish in, rubbish out,” says a Senior Microbiologist at Barts’ Heath NHS Trust. “The need for change is likely to be politically driven, rather than scientifically.”  The science is evident, the political will is not.

The lack of any protocol for urine collection is causing persistent, widespread and expensive diagnostic failure that starts in the GP surgery. For unreliable frontline diagnoses lead to critical conditions, hospital admissions, and expensive, complex treatment, not to mention the millions of patients who continue to suffer. This is not the fault of our hardworking and overstretched GPs and frontline nursing staff.  It is our healthcare leaders who persistently overlook the need to make urine analysis and treatment right-first-time.

Take urinary tract infection (UTI), a condition largely suffered by women. The last relevant data to come out of the NHS Unplanned Admissions Committee cites untreated UTI as the cause of 184,000 unplanned hospital admissions that cost the NHS £434m to treat (2013/14). This is hardly surprising when we know that 20-30% of initial antibiotic prescribing for UTI fails (Chronic Urinary Tract Infection Campaign CUTIC).

The majority of these annual 15m diagnostic failures will relate to women, who with UTI, suffer the most pain, most time off work and loss of income, whilst being prescribed the highest rate of broad-spectrum antibiotics, putting us firmly in the front line of antibiotic immunity. The need for a robust protocol around urine analysis has become critical. Data from CUTIC tells us that:

  • 1.4m women suffer from chronic bladder pain and urinary dysfunction
  • 1 in 3 women will have a UTI by the age of 24
  • 50% of dipstick tests don’t detect infection
  • 70% of infections risk recurrence within a year
  • 47% of Gram-negative blood infections have a urinary source and can lead to potentially fatal sepsis

NHS Improvement advises that 50% of the global rise in Antimicrobial Resistance (AMR) has a urinary cause; yet our health service still routinely relies on unreliable dipstick tests to indicate infection, leading to broad spectrum antibiotics remaining the first prescribing port of call; for the pregnant woman this is highly undesirable as it can extend life-long risk of antibiotic immunity to the unborn child.

Overuse of antibiotics is directly linked to the lack of a protocol for urine collection, transportation and analysis. National contamination rates are as high as 70% in some areas of the country, a postcode lottery situation that fails patients, microbiologists and the clinicians whose job it is to make people better. Non-invasive and cheap to collect, urine can help diagnose myriad conditions that cost the NHS billions of pounds. They include:

  • Kidney stones, infection and disease
  • Bladder cancer
  • Diabetes mellitus
  • Hypertension
  • Liver disease
  • Pre-eclampsia and other potentially serious pregnancy related conditions

Matt Hancock, Secretary of State for Health and Professor Tim Briggs, founding father of the Department of Health’s NHS Getting It Right First Time programme (GIRFT) both cite the need to eliminate variation in national diagnosis and treatment. We must challenge them to make the changes necessary to this most basic diagnostic process, to save lives, save money and create a solid foundation upon which the evolution of diagnostic medicine can flourish.

Right now, the best digital diagnostic technology in the world that relies on urine, won’t work. If the basics are right, the rest can follow. If they are not, then Mr Hancock and Professor Briggs … keep on flushing.