Carol summarises her time at the BSAC below:
BSAC meeting – The challenge of urinary tract infections
14th June – RCP London
This BSAC meeting was convened recognising that UTI are a leading cause of bacterial bloodstream infections, but they remain a chronically neglected area of infectious diseases.
Dr Angela Huttner gave an excellent opening presentation which provided overview of what came in the rest of the meeting – being entitled Urinary Tract infection: from intellectual dead end to exciting new frontier.
Some of her reflections were:
- “Everyone gets a UTI – if haven’t then you just haven’t lived long enough!”
- “Patients, their doctors and the whole system contribute to AMR in UTI”
- “UTI is a diagnostic puzzle; we don’t know how to do it properly yet.”
The program was broad and in the second session contributions came from outside of infectious diseases with UTI challenges from the perspective of the urology surgeon, in pregnancy, in paediatrics and in renal transplants.
New frontiers and clinical practice was the next session. This covered why some UTI are so hard to diagnose and treat, introducing intracellular immunity and bacterial reservoirs of the bladder epithelium. Evidence for nitrofurantoin in current guidance and a novel approach to addressing biofilms was introduced. Then came a successful primary care audit with review of antibiotic prophylaxis in primary care, followed by research on effects of antibiotic selection on collateral susceptibility and evolution of uropathogenic E.coli.
Keynote presentations reviewed the evidence base for shortening treatment durations for UTI and considered the role of the multibiome in recurrent UTI.
The final session considered alternative approaches to antibiotic therapy for UTI, in the form of oral vaccines, intravesical and phage therapies.
I thoroughly enjoyed the entire meeting. This was the first face to face meeting for most of us in a few years. The program and the speakers were excellent, the day provided plenty of opportunities to network and additionally I became aware of people/ centres undertaking research of particular interest to myself.
Many of the sessions recognised successes with multidisciplinary team approaches to management of recurrent urinary which is of interest as Lothian adopted this model in 2019 and we continue to develop the service; with urology, ID, pharmacy, nurse and physiotherapy input to complex patients.
My poster highlighted the numbers of patients in primary care prescribed a long-term antibiotic (co-amoxiclav), most were no longer under the specialists that initiated treatment. The majority of were for urinary indications. This supports the need for antimicrobial stewardship pharmacists with a primary care focus and local overview, who through access to prescribing data, monitoring of trends, can identify potential interventions to improve stewardship. This aligned with the presentation by Avril Tucker and the approaches taken in Wales to review prescribing of antibiotic prophylaxis for UTI. I had the opportunity to discuss this with her as i am about to implement this locally.
I am grateful to CIRG for the funding to enable me to attend this meeting.
Congratulations again to Carol and all her work.
