Guidelines
Urinary Tract Infection

Urinary Tract Infection

Definitions

Presence of 1 or more species of bacteria growing in the urine at specified quantitative counts, irrespective of the presence of pyuria, in the absence of signs or symptoms attributable to UTI

Acute UTI confined to the bladder

  • Non-pregnant female
  • Dysuria, frequency, urgency, hematuria, and/or suprapublic pain
  • No signs or symptoms of upper tract or systemic infection

Symptoms:

  • Systemic (fever, chills, rigors, significant fatigue or malaise, nausea, vomiting)
  • Flank pain, CVA tenderness (suggests pyelonephritis)
  • Patients may or may NOT have cystitis symptoms

Other criteria:

  • Immunocompromised
  • Sepsis in setting of suspected UTI
  • Male
  • Recent instrumentation
  • Urinary tract catheter/stent (i.e., foreign body)
  • Structural abnormality of urinary tract (including stones)

Microbiology

  • S. aureus rarely causes UTI
  • When isolated in the urine it can be associated with S. aureus bacteremia (80% of cases)
  • Blood cultures are recommended
  • May be associated with foreign bodies & mucosal injury (e.g., catheters)
  • Candida spp. reflects colonization rather than infection when isolated in urine
  • Usually associated with foreign body in urinary tract (e.g., catheter)
  • In rare cases may cause UTI, consult ID

Notes

Avoid using the same antibiotic if recurrent UTI within 3 months

If sexually active, consider gonococcal cystitis and chlamydia infection

Additional Information

Guideline originally sourced from Saskatchewan Health Authority - Saskatoon Area and adapted by Joseph Brant Hospital

  • Gupta K, Hooton TM, Naber KG, et al. ; Infectious Diseases Society of America; European Society for Microbiology and Infectious Diseases . International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: a 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis. 2011;52(5):e103-e120.

  • Nicolle LE, Gupta K, Bradley SF, et al. . Clinical practice guideline for the management of asymptomatic bacteriuria: 2019 update by the Infectious Diseases Society of America. Clin Infect Dis. 2019;68(10):1611-1615.

  • Toronto Central LHIN: Guidelines for Empiric Treatment of Urinary Tract Infection in Adults, January 2015. Accessed Online May 2020 at: www.antimicrobialstewardship.com/uti

  • The Johns Hopkins University (2020) John Hopkins ABX Guide (1.27) [Mobile App] Retrieved from: www.hopkinsguides.com

  • Antimicrobial Therapy Inc (2020) The Sanford Guide (4.2) [Mobile App] Retrieved from: www.sanfordguide.com/

Approved: May 2020