Quality standard

Quality statement 5: Referring adults with recurrent urinary tract infection

Quality statement 5: Referring adults with recurrent urinary tract infection

Quality statement

Men with a recurrent urinary tract infection (UTI), and women with a recurrent lower UTI where the cause is unknown or a recurrent upper UTI, are referred for specialist advice. [new 2023]

Rationale

Recurrent UTIs are common but referral for specialist advice is needed when there are higher risks or when it is uncertain if the UTI is the cause of urinary symptoms. Higher risks are associated with recurrent UTIs in men, and with recurrent upper UTIs (pyelonephritis) which can lead to impaired renal function. Further consideration of the underlying reason for recurrent infection may alter management and treatment. Repeated prescription of antibiotics without identifying the underlying cause risks missing alternative conditions that may be causing the symptoms such as bladder cancer. Also, over-use of antimicrobials could result in more resistant infections. For recurrent UTIs to be identified, adults diagnosed with a UTI should have the diagnosis recorded, including the type of UTI, and coded in their patient records.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Process

a) Proportion of men with a recurrent UTI who are referred for specialist advice.

Numerator – the number in the denominator referred for specialist advice.

Denominator – the number of men with a recurrent UTI.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.

b) Proportion of women with a recurrent lower UTI where the underlying cause is unknown following clinical assessment who are referred for specialist advice.

Numerator – the number in the denominator referred for specialist advice.

Denominator – the number of women with a recurrent lower UTI where the underlying cause of recurrence is unknown following clinical assessment.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.

c) Proportion of women with a recurrent upper UTI referred for specialist advice.

Numerator – the number in the denominator referred for specialist advice.

Denominator – the number of women with a recurrent upper UTI.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.

Outcome

Number of recurrent UTIs in adults.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.

What the quality statement means for different audiences

Service providers (such as GP practices, hospitals) ensure that procedures are in place for all men with a recurrent UTI, and women with a recurrent lower UTI where the cause is unknown or a recurrent upper UTI, to be referred for specialist advice to a urology service. They ensure that specialist advice includes specialist investigation and management of recurrent UTI when appropriate.

Healthcare professionals (GPs, physician associates, hospital doctors) assess people with a recurrent UTI to understand why they are having recurrent infections. They refer men with a recurrent UTI, women with a recurrent lower UTI where the underlying cause of recurrence is unknown and women with a recurrent upper UTI (pyelonephritis) to urology for specialist advice.

Integrated care systems lead on antimicrobial stewardship in their area.

Men with a recurrent UTI, and women with a recurrent lower UTI where the cause is unknown or a recurrent upper UTI, are referred for specialist advice to help identify the reason for recurrence and manage the UTI.

Definitions of terms used in this quality statement

Recurrent UTI

Repeated UTI with a frequency of 2 or more UTIs in the last 6 months or 3 or more UTIs in the last 12 months. A recurrent UTI may be due to relapse (with the same strain of organism) or reinfection (with a different strain or species of organism). [NICE's guideline on urinary tract infection (recurrent): antimicrobial prescribing, terms used in the guideline and recommendation 1.1.2]

Lower UTI

An infection of the bladder (also known as cystitis) usually caused by bacteria from the gastrointestinal tract. [NICE's clinical knowledge summary on urinary tract infection (lower) – women, background information, definition]

Upper UTI

Infection of the upper part of the urinary tract – the ureters and kidneys (pyelonephritis). [NICE's clinical knowledge summary on urinary tract infection (lower) – women, background information, definition]

Specialist advice

Advice provided by a urology healthcare professional such as a urologist, urology nurse or clinical nurse specialist. It includes further investigation, such as using ultrasound scanning, and management. [Adapted from NICE's guideline on urinary tract infection (recurrent): antimicrobial prescribing, recommendation 1.1.4, guideline committee discussion and expert opinion]