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Rationalising the use of investigation for urinary tract infections: Analysis of 700 patients and proposal for a diagnostic algorithm.
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  • Ibifuro Dokubo,
  • Felicity Reeves,
  • Sophia Cashman,
  • Vincent Gnanapragasam
Ibifuro Dokubo
Cambridge University Hospitals NHS Foundation Trust
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Felicity Reeves
Cambridge University Hospitals NHS Foundation Trust
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Sophia Cashman
Cambridge University Hospitals NHS Foundation Trust
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Vincent Gnanapragasam
Cambridge University Hospitals NHS Foundation Trust
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Abstract

Aims: To evaluate the diagnostic yield of investigations performed on patients with a history of urinary tract infections (UTI). Methods: A retrospective review was conducted on patients who underwent cystoscopy and imaging for a history of UTI between 2014-2019 in a single UK teaching hospital. Data was collected on demographics, cystoscopy and radiological findings requiring further management. The cohort was stratified by age, gender, and a confirmed history of recurrent UTI (rUTI). The subsequent algorithm was re-tested in a second cohort to validate its use. Results: 700 patients were included in the primary analysis, 427 female and 273 males. 331 meet the criteria of rUTI. The median age was 64y(18-97). Imaging abnormalities were equally frequent in males 6.3%(15/241) and females 8%(30/380) and the majority noted in patients aged ≥55y, 30/45(66.7%). Amongst those who did not meet the definition of rUTI, abnormal imaging was identified in 5-7% regardless of age group and gender. Cystoscopy abnormalities (n=24) were twice more likely in males, 5.5%(15/273) than females, 2%(9/427). 88%(21/24) were identified in patients ≥55y. There were no positive findings in women <55y. Applying baseline imaging but confining cystoscopy to those aged ≥55y and men with a confirmed history of rUTI would have saved 44% of procedures, missed no abnormalities with an overall diagnosis detection rate of 9.8%(69/700). This algorithm was validated in a separate cohort of 63 patients; applying it would have saved 46%(29/63) of cystoscopies with a positive diagnostic rate of 9.5% and no missed findings. Conclusion: To our knowledge this is one of the largest studies reporting the outcomes of investigations for UTI and rUTI. Our result suggests that imaging is a useful baseline assessment, but cystoscopy should be limited to specific subgroups. We propose and validate a simple decision algorithm to manage investigations for referrals for UTI in secondary care.

Peer review status:Published

28 Oct 2020Submitted to International Journal of Clinical Practice
01 Nov 2020Assigned to Editor
01 Nov 2020Submission Checks Completed
16 Nov 2020Reviewer(s) Assigned
18 Dec 2020Review(s) Completed, Editorial Evaluation Pending
21 Dec 2020Editorial Decision: Accept
12 Jan 2021Published in International Journal of Clinical Practice. 10.1111/ijcp.13977