emDocs - April 2, 2018 - Author: Long B - / Edited by: Koyfman A
"Key Points
- UTI is a clinical diagnosis (dysuria, frequency, etc.). Urine that is cloudy or “smelly” is not diagnostic of UTI. LE or nitrites alone without symptoms does not require treatment.
- Patients with simple, routine UTI do not require urine cultures. Patients with complicated UTI, pyelonephritis, failed treatment, or recent antibiotic therapy should have urine cultures obtained.
- Bacteriuria in the absence of symptoms defines asymptomatic bacteriuria, which should not be routinely treated.
- Patients with dementia and falls or those with altered mental status and no ability to provide a history of urinary symptoms can be difficult. Negative nitrite and LE rules out UTI in ASB and in patients for whom exam is challenging.
- Other markers of systemic inflammation should be used for diagnosis if history or exam are unreliable."