PrescQIPP

Confronting antimicrobial resistance: Getting UTI treatment right first time

Betsi Cadwaladr University Health Board

Project summary

To tackle antimicrobial resistance, the antimicrobial pharmacy team at Betsi Cadwaladr University Health Board (BCUHB) worked collaboratively with the medicines management team and GP practices, to co-designed a patient centred project to improve appropriate antimicrobial prescribing for the treatment of lower urinary tract infection (UTI), via the local prescribing incentive scheme in 2022. The project was launched across 98 practices focusing on one message “Trimethoprim should only be used when recent urine culture shows sensitivities for the treatment of UTI in age 65 and above” due to significant resistance in this age group. The project was funded for a year, but the impact of the project shows continues to show sustainable improvements in prescribing. The health board has achieved:

  • 70-100% compliance in appropriate use of Trimethoprim when audited during the project in 63% of GP in BCUHB (57 practices) by March 2024

  • 40% reduction in Trimethoprim usage in DDD per 1000 patients units by December 2025

  • 14% reduction in ALL UTI usage (Trimethoprim, Nitrofurantoin, Pivmecillinam & Fosfomycin) by December 2025

  • 11% reduction in community onset E. Coli bacteraemia from 2023/2024 to 2025/2026

This project was needed because:

  • The antibacterial resistance in urine coliforms Wales report (2016-2023) showed that Betsi Cadwaladr University Health Board had the second highest Trimethoprim resistance (30.5%) in Wales from E. coli community urine samples. There were higher resistances rates in the older age group (65 and over).

  • BCUHB had the third highest Trimethoprim usage in Wales during 2023/2024

  • E. coli bacteraemia rate was also on the rise, with rate of infection increased from 63.46 total rate per 100,000 population in 2021/2022 to 79.34 total rate per 100,000 population in 2023/2024.

The project tackles antimicrobial resistance through optimising the use of antimicrobials. It fulfilled the aim of the UK 5-year action plan for antimicrobial resistance 2024-2029 to improve the use of antimicrobials and preserve its future effectiveness through antimicrobial stewardship. Our population in North Wales received the right antibiotic to treat their UTI first time, reduced further unnecessary exposure to antibiotic and prevented hospital admission due to untreated UTI or sepsis.