Urinary Tract Infections
When to Send a Urine for Culture and Urinalysis

When to Send a Urine for Culture and Urinalysis

  • In elderly patients without localizing genitourinary symptoms or other systemic signs of infection, whether catheterized or not, the presence of delirium, increased falls, dizziness, altered behavior or decreased appetite do NOT warrant collection of a urine culture and urinalysis for assessment for UTI.

Choose Patient Status

  • Do NOT send urine for culture and/or urinalysis, unless pregnant or for urologic procedure where mucosal bleeding expected.
  • Work-up other cause for symptoms

UTI Symptoms

  • Dysuria
  • ↑ Frequency
  • ↑ Urgency
  • Suprapubic pain
  • Fever
  • Acute hematuria
  • Delirium
  • Rigors
  • Flank Pain
  • ± Lower tract symptoms if catheter removed
  • Fever
  • Nausea, vomiting
  • Costovertebral pain
  • Flank pain
  • ± Lower tract symptoms

Cloudy and/or foul smelling urine are NOT symptoms of UTI

Clinical Pearls

  • Urine culture and susceptibility and urinalysis testing are NOT necessary or beneficial in healthy, non-pregnant, premenopausal, non-diabetic women with acute cystitis (at least 2 of 3 cardinal symptoms – dysuria, urgency or frequency) and NO vaginal discharge without functional or anatomical abnormalities of the urinary tract.

Always obtain a culture for the following patients:

  • Pregnant women
  • Patients with sign and symptoms of pyelonephritis
  • Premenopausal adult females with recurrent cystitis
  • Urological procedure
  • Patients with complicated urinary tract infections (i.e. structural abnormality, obstruction, recent urologic procedure, male sex, immunosuppression, poorly controlled diabetes, spinal cord injury or catheterization)

Urine cultures should NOT be obtained for:

  • Elderly patients with an abnormal urinalysis without UTI symptoms
  • Cloudy/foul-smelling urine without UTI symptoms
  • Insertion or replacement of a urinary catheter
  • Routine screening or standing orders
  • Test of cure unless persistent or recurrent symptoms or pregnant
  • Blocked catheter