Judicious Antibiotic Use in Long Term Care Facilities Program

Urinary Tract Infection: Diagnosis (part 3)

For Non-Catheterized Patients:

The chart below is based on guidelines published in 2001 by the Society of Healthcare Epidemiology of America, and describes diagnostic criteria for urinary tract infection in non-catheterized patients. (1)

• The diagnostic focus should be onacute urinary tract symptoms.

• Laboratory evaluation (urinalysis and culture) should generally only be done in the presence of acute urinary symptoms.

• Fever + Bacteriuria does not equal clinical UTI
  • Bacteriuria is common in this population
• Only about 10% of cases of fever without urinary findings in non-catheterized residents are due to urinary tract infection. The positive predictive value of a positive urine culture in this situation is 12%. (2)

For Catheterized Patients:

The chart below is based on guidelines published in 2001 by the Society of Healthcare Epidemiology of America, and describe diagnostic criteria for urinary tract infection in catheterized patients. (1)

• Patients with indwelling urinary catheters are at much higher risk of urinary tract infection.

• Patients with indwelling urinary catheters in place may not have typical symptoms of urinary tract infection.

• Fever or other non-localizing symptoms may be only sign of clinically important urinary tract infection in the catheterized patient

• Bacteriuria is nearly universal in chronically catheterized patients.

• Patients with foul-smelling or cloudy urine without other symptoms should not be treated with antibiotics in the absence of other symptoms. Urine cultures should not be obtained in this situation.

   

References:

1. Loeb et al. Development of Minimum Criteria for the Initiation of Antibiotics in Residents of Long-Term-Care Facilities: Results of a Consensus Conference. Inf Con Hosp Epi 2001;22:120-124.

2. Orr P, Nicolle LE, Duckworth H, et al. Febrile urinary infection in the institutionalized elderly. Am J Med 1996; 100:71-77.