- Last edited on August 21, 2026
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on-call:approach-to-im-on-call-emergencies-issues [on February 4, 2024] psychdb [Table] |
on-call:approach-to-im-on-call-emergencies-issues [on August 21, 2026] (current) psychdb [Urinary Tract Infections] |
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| ===== Urinary Tract Infections ===== | ===== Urinary Tract Infections ===== | ||
| - | * Do not treat asymptomatic bacteria in the elderly.[([[https://academic.oup.com/cid/article/68/10/e83/5407612|Nicolle, L. E., Gupta, K., Bradley, S. F., Colgan, R., DeMuri, G. P., Drekonja, D., ... & Siemieniuk, R. (2019). Clinical practice guideline for the management of asymptomatic bacteriuria: 2019 update by the Infectious Diseases Society of America. Clinical Infectious Diseases, 68(10), e83-e110.]])] | + | * Collect urine cultures from adults only if they have symptoms localizing to the urinary tract or fever, are pregnant, or are undergoing genitourinary instrumentation where mucosal bleeding is expected.[([[https://choosingwiselycanada.org/recommendation/medical-microbiology/.|Wong, D. Appropriate use of diagnostic tests in medical practice.]])] |
| + | * Urine cultures should only be ordered in those with true UTI symptoms (e.g., dysuria, urinary frequency, hematuria, absence of vaginal discharge, irritation, flank pain, suprapubic pain. | ||
| + | * There is a misconception that urine should be sterile but the urinary system possesses its own unique microbiome that protects humans from true infections. Unnecessary antibiotic exposure might paradoxically increase the risk of developing a UTI. | ||
| + | * Geriatric patients are frequently subjected to unnecessary urine tests and overtreatment with antibiotics, because asymptomatic bacteriuria is present in up to 50% samples.[([[https://academic.oup.com/cid/article/68/10/e83/5407612|Nicolle, L. E., Gupta, K., Bradley, S. F., Colgan, R., DeMuri, G. P., Drekonja, D., ... & Siemieniuk, R. (2019). Clinical practice guideline for the management of asymptomatic bacteriuria: 2019 update by the Infectious Diseases Society of America. Clinical Infectious Diseases, 68(10), e83-e110.]])] | ||
| + | * In those with indwelling Foley catheters, the bacterial colonization rate is near 100% after 2 weeks of catheterization. | ||
| + | * Therefore, in these patients, urine culture should be obtained only if fever, new costovertebral tenderness, rigors, or new-onset delirium without another obvious cause is present. | ||
| + | * Antibiotic treatment in patients with delirium and bacteriuria //without// UTI symptoms does not improve mental status or functional outcomes. | ||
| ===== Other Lab Abnormalities ===== | ===== Other Lab Abnormalities ===== | ||