Does your patient really have a UTI?

 

Background

 

How often do we test the urine of patients with no urinary symptoms? How often are we prompted to send samples for culture after a random dipstick test? How often are these patients prescribed antibiotics even when they have no clinical signs of a UTI? If your Emergency Department is anything like mine, each of these things happen quite often.

 

"What's the harm?" you may ask. Well, besides poor use of resources, there are the side effects of treatment, increasing antimicrobial resistance, and the risk that you miss another condition because you stop workup when a UTI is 'found'.

 

Like any test, you've got to know why you're running it and what you are looking for.

 

  • Suspected renal colic? Useful test
  • Urinary frequency, urgency, dysuria or suprapubic pain? Useful test
  • Abdominal pain or PV bleeding in a woman of child-bearing age? Useful test
  • Type 1 diabetic with abdominal pain and vomiting? Useful test
  • Pregnant woman with hypertension and headache? Useful test
  • Elderly lady who is a little more confused than usual? Actually not so useful
  • Gentleman who fell while getting out of the bath? Not useful
  • Middle-aged lady who had an episode of chest pain? No
  • Young chap with a cough? Oh come on!

 

 

The paper

 

Nicolle L, Gupta K, Bradley S. Clinical practice guideline for the management of asymptomatic bacteriuria: 2019 update by the Infectious Diseases Society of America. Clin Infect Dis. March 2019 [Epub ahead of print]​[1]​

 

For detailed show notes please visit our website: https://the-breach.com

 

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