Abstract
Background: Urinary tract infections (UTIs), a contributing cause of urinary symptoms such as urinary incontinence (UI) and overactive bladder (OAB), are prevalent concerns among older adults in care home settings, with an estimated lifetime risk ranging from 50% to 60%. Due to urinary problems, incontinence pads alone are estimated to cost the NHS £80 million annually. This financial impact is compounded by the costs associated with treating UTIs. In 2020–21, the NHS spent £37 million on antibiotics for UTIs, which could otherwise have funded 1,480 newly qualified nurses for a year. The excessive treatment of suspected UTIs and the inappropriate management of asymptomatic bacteriuria (ASB) contribute significantly to antibiotic overuse and the emergence of antimicrobial resistance. Such overuse can lead to the persistence of resistant bacteria in the bladder for up to a year and heightens the risk of recurrent infections. Current guidelines emphasise prompt, targeted antibiotic therapy for older or frail patients, highlighting the urgent need for a non-invasive, affordable and accurate tool to diagnose and differentiate UTIs from bacteriuria. This could pave the way for the development of a point-of-care (POC) test to improve UTI diagnosis and management in care home settings.Methods: This study aimed to address challenges faced by care home staff and residents by implementing a face to face educational intervention on continence care, with a focus on the relationship between urinary symptoms and UTIs. The training sought to enhance healthcare professionals' knowledge and skills, measured using pre- and post-quiz scores as baseline metrics. Biomarker analysis was conducted using the multiplex luminex assay, with findings evaluated against the gold standard urine culture and microscopy.
Results: The Face to face training intervention led to significant improvements in quiz scores pre- and post-training (p=0.001), with staff knowledge increasing across all demographics (p<0.001). The programmes' success in resolving these urgent problems was further confirmed by the fact that all five managers reported fewer urinary symptoms after training (Chapter 2). Findings from the study on the potential of urinary biomarkers, including IL-6, MCP-1, IL-1β, and lactoferrin, for diagnosing UTIs in care home residents with comorbidities (Chapter 3) identified using urine culture mixed growth bacteriuria in 48 out of 56 participant samples, with three samples which tested positive for UTI and five samples with no bacterial growth. The european committee on antimicrobial susceptibility testing (EUCAST) breakpoint table was used to analyse the antimicrobial susceptibility testing findings for two participants with positive urine cultures. E.coli was resistant to trimethoprim, indicated by bacterial growth and coliform bacteria exhibited no resistance to any of the antibiotics tested. The statistical analysis performed on the biomarkers showed no significant biomarker differences between UTI and non-UTI cohorts (MCP-1, p=0.870; IL-6/Cr p=0.740; IL-1β/Cr, p=0.385; lactoferrin/Cr p=0.117).
Discussion: The educational intervention improved staff knowledge and reduced urinary symptoms, while biomarker analysis found no significant differences between UTI and non-UTI subgroups. These findings reinforce the importance of continued efforts to improve UTI management and develop innovative diagnostic approaches, which are crucial for reducing healthcare costs and mitigating antimicrobial resistance.
| Date of Award | 25 Apr 2025 |
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| Original language | English |
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| Supervisor | Sarah Hill (Supervisor) & John Young (Supervisor) |