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Background  A midstream specimen of urine (MSU) culture is a diagnostic test commonly used to guide the management of suspected lower urinary tract infections (LUTI). Inappropriate use of MSUs leads to unnecessary treatment of asymptomatic bacteriuria, delayed antibiotic prescriptions, and increased costs.    Aim  This audit investigates the use of MSUs in a primary care practice in Birmingham before and after an educational intervention designed to increase adherence to guidelines.    Method  All MSUs sent during June and July 2017 for non-pregnant adults were audited. Patient demographics, request details, indications, dipstick results, and relevant prescriptions were extracted from the electronic record. Clinical management was compared with the National Institute for Health and Care Excellence (NICE) quality standard QS90. Results were presented to practice staff; training based on QS90 was given and supported by new management algorithms. Re-audit was then undertaken over another 2-month period.    Results  The audit included 157 samples, with a further 138 samples in the re-audit. The proportion of MSU samples that were clinically indicated increased from 66% to 77% following the educational intervention. Suspected LUTI was the most common indication in both audit cycles: 68% and 64% respectively. Adherence to QS90 increased from 68% to 84% and improvements were seen among both doctors (71% to 78%) and practice nurses (36% to 55%).    Conclusion  Educational intervention and the introduction of management algorithms improved adherence to NICE QS90. There is scope for enhancement with further education and uptake of management algorithms. The cohort is small and limited to one practice, but could easily be repeated on other sites.

An audit on the use and utility of midstream specimen of urine cultures in general practice