Adult Guidance
Lower Urinary Tract Infection

Lower Urinary Tract Infection

Definition

Infection of the lower part of the urinary tract (e.g. the bladder-cystitis)

Urinary tract infections (UTI) in individuals with structural anomalies of the urinary tract or who are immunocompromised and in pregnant women are generally considered at greater risk of complicated evolution (complicated UTI)

Diagnosis

Acute (<1 week) dysuria, increased urinary urgency and frequency, lower abdominal pain or discomfort and sometimes gross hematuria

  • In women, a vaginal source of the symptoms (vaginal discharge or irritation) should be excluded first
  • In elderly patients with pre-existing urinary symptoms the most reliable symptoms are acute urinary changes compared to the baseline

In symptomatic patients:

  • Urine culture if risk of complicated UTI and/or recurrent UTI (to confirm the diagnosis and adapt empiric treatment)

Important:

  • A positive urine culture in an asymptomatic patient indicates bacterial colonization and does not require treatment except in pregnant women or in patients undergoing urological procedures in which bleeding is anticipated
  • The absence of urine leucocytes has a good negative predictive value but the positive predictive value of leucocyturia is suboptimal

In symptomatic patients:

  • Urinalysis (dipstick or microscopy) to detect bacteriuria and/or indirect signs of infection (positive leucocyte esterase and nitrites)
  • Blood tests usually not needed

Usually not needed unless need to investigate possible underlying abnormalities of the urinary tract

Microbiology

Treatment

Antibiotic treatment recommended if compatible clinical presentation AND a positive test (positive urine leucocytes/leucocyte esterase or positive urine culture)

  • If tests could not be performed, treat based on clinical presentation
  • Clinical improvement should be evident within 48-72h
  • Antibiotics shorten duration of symptoms by 1-2 days