Urinary Tract Infection

Diagnosis • History. Diagnosis is made primarily by history. In women with dysuria and frequency, in the absence of vaginitis, the diagnosis is UTI 80% of the time [evidence: C*]. • Phone triage. In women with prior history of uncomplicated UTI's, consider phone triage [C*]. • Urinalysis. Urinalysis for detection of pyuria by dipstick or microscope has a sensitivity of 8090% and a specificity of 50% for predicting UTI [B*]. • No urine culture. Urine culture is NOT indicated in the vast majority of UTI’s. UC has a sensitivity of 50% (if threshold for positive is >10 organisms), sensitivity can be increased to >90% if threshold is >10 organisms [C*]. Consider urine culture only in recurrent UTI or in the presence of complicating factors. Treatment • First line three days of trimethoprim / sulfa [A*]. • Second line three days of quinolone (contraindicated in pregnancy) [A*]. seven days of nitrofurantoin, amoxicillin, 1° cephalosporin [A*]. Follow-up • No tests if asymptomatic. No laboratory follow-up is necessary if asymptomatic [B*]. • For recurrent UTI’s. In patients with recurrent UTI's (>3 / year) – consider prophylaxis / self-initiated therapy [A*] – urologic structural evaluation rarely indicated [D*]