A significant decrease in Urinary tract infection (UTI) diagnoses due to the COVID-19 pandemic raises concern

The global SARS-CoV-2 pandemic changed primary care tremendously when persons with COVID-19 like symptoms were discouraged from visiting their GPs. This resulted in a decrease of patients accessing primary care services and a drop in diagnoses, including UTI. The weekly rate of UTI diagnosis per 100,000 population dropped from average of 30-35 to less than 10 between 30 March and 24 April 2020. Since April, the rate has risen no higher than 50% of the usual.

The pandemic resulted to fewer urine samples to be handed in. The fewer infections that are seen in primary care, the fewer antibiotics are prescribed. Whether this impact will be positive or negative to antimicrobial resistance (AMR) prevalence remains to be seen, but if we are not taking urine samples from those who have symptoms, we remain in the dark about the most appropriate management strategy and could therefore be encouraging bacterial resistance to antibiotics.

In recent years, clinicians have been encouraged to reduce the prescription of broad-spectrum antibiotics, including cefalexin, co-amoxiclav, and ciprofloxacin. Interestingly, prescribing of all these antibiotics for the elderly in England has increased since March 2020. The pressure to manage elderly patients at home during the pandemic could have led to the increase. Broad-spectrum antibiotics are often favored when clinicians do not know what is causing the patient’s symptoms, nor which antibiotic will be most effective. Of greater concern, however, is the 30% decrease observed in the number of sepsis hospital admissions between March and April 2020. Non-COVID-19 related deaths at home in England increased by almost 47% during the same

time period which raises the question of whether sepsis patients are being missed due to changes in patient management brought about by COVID-19.

The true impact of the pandemic on the management of common community-acquired infections including UTIs remains unknown, and certainly presents a unique opportunity for a natural experiment in terms of AMR.

Read the entire article by Dr Ashley Hammond, Senior Research Associate, University of Bristol at https://www.bsac.org.uk/plumme...