title: Local audit: How tightly should we police antibiotic prescribing for urinary tract infection and how should we modify national policy?
abstract: OBJECTIVE
  In 2010, our hospital, in line with National guidance, changed advice on antibiotic prescribing for UTI to reduce use of cephalosporins in favour of penicillins. We hypothesized that this change in policy would have no impact on the pattern of antibiotic resistance of the organisms causing UTI.
  
  
  METHODS
  Audit review of all urine samples sent to BWH from 2009 to 2013 and positive cultures showing Enterobacteriaceae were then tested for antibiotic susceptibility.
  
  
  RESULTS
  There has been an increase in the resistance of both Co-amoxiclav and Ciprofloxacin since 2009. Co-amoxiclav and trimethoprim now have similar resistance rates. Ciprofloxacin resistance has risen fairly quickly in the last four years from 1% to 8%. Resistance to nitrofurantoin has remained low. Gentamicin resistance remained stable and very low, second best to meroponem.
  
  
  CONCLUSIONS
  The results have been fed back to commissioners and internally and are being used as part of the guideline updating process.
  
  
  CONCLUSIONS
  Hospital protocols for treating infections should be reviewed and updated based on accurate local data. These data should be used for formulating regional specific protocols. Our results suggest that meroponem and ciprofloxacin should be reserved for microbiologically proven resistance to other antibiotics.
authors.affiliation: Birmingham Women's NHS Foundation Trust, Birmingham, UK amallia_brair@hotmail.com.
authors.forename: Amallia
authors.initials: A
authors.lastname: Brair
authors.affiliation: Birmingham Women's NHS Foundation Trust, Birmingham, UK.
authors.forename: Philip
authors.initials: P
authors.lastname: Toozs-Hobson
authors.affiliation: Birmingham Women's NHS Foundation Trust, Birmingham, UK.
authors.forename: Jim
authors.initials: J
authors.lastname: Gray
mesh_terms: D019980:Amoxicillin-Potassium Clavulanate Combination / Q000494:pharmacology; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D002939:Ciprofloxacin / Q000494:pharmacology; D054869:Clinical Audit; D024881:Drug Resistance, Bacterial; D004739:England; D004755:Enterobacteriaceae / Q000187:drug effects*; D004756:Enterobacteriaceae Infections / Q000188:drug therapy*; D005260:Female; D005839:Gentamicins / Q000494:pharmacology; D006291:Health Policy; D006801:Humans; D000077731:Meropenem; D008826:Microbial Sensitivity Tests; D009582:Nitrofurantoin / Q000494:pharmacology; D017410:Practice Guidelines as Topic; D013845:Thienamycins / Q000494:pharmacology; D014295:Trimethoprim / Q000494:pharmacology; D014552:Urinary Tract Infections / Q000188:drug therapy* / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents; D005839:Gentamicins; D013845:Thienamycins; D002939:Ciprofloxacin; D019980:Amoxicillin-Potassium Clavulanate Combination; D009582:Nitrofurantoin; D014295:Trimethoprim; D000077731:Meropenem
keywords: Antibiotics; Birmingham's Women's NHS Foundation Trust; UTI; antimicrobial resistance; resistance; urogynaecology