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This guideline has been registered with the Trust. Clinical guidelines are guidelines only. The interpretation and application of clinical guidelines will remain the responsibility of the individual clinician. If in doubt contact a senior colleague. Caution is advised when using guidelines after a review date.
Diagnosis of UTI in Adults - Quick Reference Guide Version • 2.0 Date ratified • November 2008 Review date • November 2010 Ratified by • Nottingham Antibiotic Guidelines Committee Authors • • Tim Hills (Senior Pharmacist Microbiology and Infection Control) Dr Vivienne Weston (Consultant Microbiologist) Consultation Mr John Lemberger (Consultant Urology) Drs Ivan Le Jeune and Robert Hawkins (Consultants, Acute Medicine) • Nottingham Antibiotic Guidelines Committee members Evidence base • • Local microbiological sensitivity surveillance Recommended best practice based on clinical experience of guideline developers Changes from previous Guideline • Formal assessment of clinical features of UTI added to algorithm Inclusion criteria • Adult patients where UTI is within the differential diagnosis Distribution This guideline will be available on the Trust antibiotics guidelines websites: http://nuhweb/antibiotics and http://www.nuh.nhs.uk/antibiotics • Laminated and displayed on appropriate adult wards • This guideline will be included in the NUH Formulary update Local contacts • • • • Dr V Weston Consultant Microbiologist This guideline has been registered with the Trust Clinical guidelines are guidelines only The interpretation and application of clinical guidelines will remain the responsibility of the individual clinician If in doubt contact a senior colleague Caution is advised when using guidelines after a review date Nottingham Antibiotic Guidelines Committee November 2008 Review November 2010 Authors: Tim Hills, Dr Weston In consultation with: Mr Lemberger (urology), Drs Le Jeune, Hawkins (Acute medicine) Page of Diagnosis of UTI - Quick Reference Guide INTRODUCTION Dipstick urinalysis with nitrite and leucocyte esterase (LE) provides a useful and quick near-patient-test for the exclusion of Urinary tract infection (UTI) – 95% negative predictive value (NPV) if both nitrite and LE negative However they are slightly less specific with a positive predictive value (PPV) if either one or both are positive of around 40-60% with random testing, therefore a positive result should be confirmed by microbiological examination in hospital in or outpatients who are at higher risk of having a complicated or resistant infection and clinical assessment is also required UTI can only be proven bacteriologically in 50% of women with symptoms of UTI, others have inflammation of the urethra – the ‘so called’ urethral syndrome Antibiotics not hasten the clinical response in urethral syndrome In catheterised patients a positive dipstick urinalysis is normal and unhelpful, avoid unnecessary samples and treatment of bacteriuria, only sample/treat culture result if signs of systemic infection are present SUSPECTED UTI: Patient with suspected UTI, see above for catheterised patients Dipstick for urine leucocyte esterase (LE) blood, protein and nitrite Positive nitrite and/or LE +/- protein, +/- blood Possible UTI Negative nitrite & LE UTI unlikely (95% NPV) +/- protein, +/- blood Does patient have features indicative of UTI? (dysuria, frequency, new incontinence, loin, flank or suprapubic tenderness) Yes , send MSU Does patient have features indicative of UTI? (dysuria, frequency, new incontinence, loin, flank or suprapubic tenderness) Yes, send MSU Treat according to UTI or urosepsis guidance on the antibiotic website http://nuhweb/antibiotics , review with culture results Wait for culture result Only treat empirically if patient has features indicative of UTI and is septic, (see urosepsis guidance on the antibiotic website) No No evidence of UTI No Asymptomatic bacteruria in the elderly is very common It is not related to increased morbidity or mortality and giving antibiotics does not improve outcome Investigation and treatment will increase side-effects (including C.Diff infection) and medicalise the condition ASYMPTOMATIC BACTERURIA Asymptomatic bacteruria in the elderly is very common and is not related to increased morbidity or mortality Investigation and treatment will increase side-effects and medicalise the condition Screening for asymptomatic bacteruria: Screening of asymptomatic bacteruria and treatment if positive is indicated at least once in early pregnancy and in those who are to undergo urological procedures where mucosal bleeding is expected e.g TURP References Devillé WLJM et al The urine dipstick test useful to rule out infections A meta-analysis of the accuracy BMC Urology 2004 available from http://www.biomedcentral.com/1471-2490/4/4 accessed 6.4.2006 Patel HD et al, Can urine dipstick testing for urinary tract infection at point of care reduce laboratory workload? J Clin Pathol 2005;58:951-954 ISDA guidelines for the Diagnosis and Treatment of Asymptomatic Bacteriuria in Adults CID 2005; 40:643–54 Nottingham Antibiotic Guidelines Committee November 2008 Review November 2010 Authors: Tim Hills, Dr Weston In consultation with: Mr Lemberger (urology), Drs Le Jeune, Hawkins (Acute medicine) Page of ... required UTI can only be proven bacteriologically in 50% of women with symptoms of UTI, others have inflammation of the urethra – the ‘so called’ urethral syndrome Antibiotics not hasten the clinical... tract infection (UTI) – 95% negative predictive value (NPV) if both nitrite and LE negative However they are slightly less specific with a positive predictive value (PPV) if either one or both... sample/treat culture result if signs of systemic infection are present SUSPECTED UTI: Patient with suspected UTI, see above for catheterised patients Dipstick for urine leucocyte esterase (LE) blood, protein