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    Diagnostic Criteria For Urinary Tract Infection

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    candyslibio
    This document provides diagnostic criteria and guidelines for diagnosing and treating urinary tract infections in non-catheterized adults. It states that patients should be assessed for urinary symptoms and that a urinalysis checking for white blood cells and nitrites can help determine if a mid-stream urine sample should be collected and antibiotics initiated. For catheterized patients, urinalysis is not useful for diagnosing infection since catheters often become colonized, and antibiotics alone will not eradicate bacteriuria without catheter change. Asymptomatic bacteriuria in elderly patients should not be treated.

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    Diagnostic Criteria For Urinary Tract Infection

    Uploaded by

    candyslibio
    136 views2 pages
    This document provides diagnostic criteria and guidelines for diagnosing and treating urinary tract infections in non-catheterized adults. It states that patients should be assessed for urinary symptoms and that a urinalysis checking for white blood cells and nitrites can help determine if a mid-stream urine sample should be collected and antibiotics initiated. For catheterized patients, urinalysis is not useful for diagnosing infection since catheters often become colonized, and antibiotics alone will not eradicate bacteriuria without catheter change. Asymptomatic bacteriuria in elderly patients should not be treated.

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    Diagnostic Criteria for Urinary Tract Infection

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    This document provides diagnostic criteria and guidelines for diagnosing and treating urinary tract infections in non-catheterized adults. It states that patients should be assessed for urinary symptoms and that a urinalysis checking for white blood cells and nitrites can help determine if a mid-stream urine sample should be collected and antibiotics initiated. For catheterized patients, urinalysis is not useful for diagnosing infection since catheters often become colonized, and antibiotics alone will not eradicate bacteriuria without catheter change. Asymptomatic bacteriuria in elderly patients should not be treated.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    136 views2 pages

    Diagnostic Criteria For Urinary Tract Infection

    Uploaded by

    candyslibio
    This document provides diagnostic criteria and guidelines for diagnosing and treating urinary tract infections in non-catheterized adults. It states that patients should be assessed for urinary symptoms and that a urinalysis checking for white blood cells and nitrites can help determine if a mid-stream urine sample should be collected and antibiotics initiated. For catheterized patients, urinalysis is not useful for diagnosing infection since catheters often become colonized, and antibiotics alone will not eradicate bacteriuria without catheter change. Asymptomatic bacteriuria in elderly patients should not be treated.

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    Diagnostic criteria for Urinary Tract Infection in non-catheterised adults

    (including complicated UTI and pyelonephritis, excluding pregnant women)
































    Does the patient have any convincing symptoms of a suspected UTI?
    Common symptoms include dysuria, frequency, urgency, new incontinence, suprapubic
    pain/tenderness. Occasionally haematuria and polyuria.
    OR
    Does the patient have clinical features suggestive of pyelonephritis?
    Symptoms include fever, rigors, vomiting, loin/flank tenderness/pain.


    No Yes
    If NO symptoms
    present:-
    x - DO NOT perform
    urinalysis
    x - DO NOT initiate
    empirical antibiotics for
    UTI

    3 Urinary
    symptoms
    Send MSU
    *

    Treat with
    empirical
    antibiotics (see
    these guidelines)
    Review
    antibiotic with
    culture and
    sensitivity results
    1-2 Urinary
    symptoms
    Perform urinalysis for
    leucocyte and nitrite
    Positive Nitrite
    (+/- leucocyte)
    Send MSU
    *

    Treat with
    empirical
    antibiotics (see
    these guidelines)

    Positive leucocyte
    and negative nitrite
    Send MSU
    *

    Only treat with empirical antibiotics if
    clinically septic (see local guidelines)
    Review antibiotic with culture and
    sensitivity results and clinical progress
    Stop antibiotics if UTI excluded and
    systemically well


    Urinalysis
    Urinalysis only has a role in the diagnosis of UTI after initial clinical assessment of the patient. If the patient has no urinary
    symptoms (as listed above) then perfoming urinalysis to screen for, or diagnose UTI, has no role whatsoever.

    The only elements of urinalysis using dipsticks that are relevant to the diagnosis of UTI are leucocyte esterase and nitrite.
    Urinalysis results for protein, glucose, ketones, blood and pH have no relevance when trying to find evidence of a patient having
    UTI.

    In catheterised patients, after a few days all catheters will be colonised and many will have caused some degree of catheter
    irritation leading to pyuria and bacteriuria. Therefore performing urinalysis on a catheterised patient has no diagnostic value for UTI.

    Urine Samples
    * Collect carefully taken urine sample before commencing antibiotic and send for microbiological testing.
    Mid-stream specimen of urine (MSU) is the commonest sample of choice.
    CSU specimens are generally of poor quality and the results of microbiological testing of CSUs correlate poorly with genuine
    clinical infection of the urinary tract. See note on catheters below.
    NB: CSU specimens will only be routinely processed if accompanied by clinical details indicating systemic infection or loin pain, or if
    the request indicates that the catheter is newly inserted.

    If the patient is systemically unwell or has features of pyelonephritis send blood cultures.

    Asymptomatic bacteriuria of the Elderly
    In the elderly (>65years), do not treat asymptomatic bacteriuria (AB). It occurs in 25% women and 10% men and is not associated
    with increased morbidity. Inappropriate treatment of AB increases side effects and antibiotic resistance.

    Catheters
    All urinary catheters become colonised with micro-organisms after a few days. Asymptomatic colonisation does not require
    urinalysis to check for suspected infection or sending a CSU for microbiological testing. Asymptomatic catheter colonisation does
    not require antibiotic treatment. In the presence of a urinary catheter, antibiotics will not eradicate bacteriuria. If the patient has
    catheter colonisation consider catheter change or removal.
    Only treat a suspected catheter-associated UTI if patient systemically unwell or pyelonephritis symptoms present. Treatment is
    antibiotics combined with catheter removal / change.

    Information taken from
    - Guidelines on Urological Infections 2010 written by the European Association of Urology
    - Diagnosis of UTI Quick reference guide for Primary Care HPA
    - SIGN guidelines Management of suspected bacterial urinary tract infection in adults, July 2006

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