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November 2017

Don’t dipstick for UTI



A new advice bulletin for GP practices says that in most cases, dipsticking urine to diagnose urinary tract infection is inappropriate and unnecessary.

The Community Infection Prevention Control division of Harrogate and District NHS Foundation Trust’s latest bulletin states that in the absence of urinary symptoms, GPNs should not dipstick urine.

‘Many people over the age of 65 years, and everyone with a long-term catheter will have bacteria in their urine, which do not cause infection. Asymptomatic bacteriuria is not a disease, and does not require treatment, except in pregnant women.

‘A positive nitrate result does not distinguish between asymptomatic bacteriuria and a genuine UTI.’

Urine should only be dipped if the patient has clinical signs of infection, including loin, back pain or pain on micturition, frequency or urgency, fever, and in elderly patients, new onset confusion, which can be a urinary symptom.

Specimens of urine should only be sent for laboratory analysis if the patient has both clinical signs of a UTI and a positive dipstick result.

The aim of the advice is to prevent the unnecessary prescribing of antibiotics, which if inappropriate, risks the development of multi-resistant bacteria and may precipitate a clostridium difficile infection.

The IPC group has produced a short training video, To dip or not to dip, available at https://www.youtube.com/watch?v=rZ5T1Cz7DHQ