Urinary Tract Infection (UTI)

Urinary Tract Infection (UTI)


Isolation of bacteria in an appropriately collected urine specimen obtained from a person without symptoms or signs referable to urinary infection

  • Females: ≥100,000 cfu/mL in 2 consecutive urine specimens
  • Males: ≥100,000 cfu/mL from a single urine specimen
  • Catheter: ≥100,000 cfu/mL of ≥1 bacteria from a single urine specimen

Does not require any further diagnostic testing or treatment

Symptomatic bladder or kidney infection in a female with a normal genitourinary tract

Symptomatic bladder or kidney infection in male or female with functional or structural abnormalities of the genitourinary tract (i.e. recent urological procedure, ureteral stents)

Symptomatic lower urinary tract/bladder infection


  • Dysuria

  • Increased urinary urgency and/or frequency

  • Suprapubic pain

  • Fever

Symptomatic upper urinary tract/kidney infection


  • Dysuria

  • Increased urinary urgency and/or frequency

  • Suprapubic pain

  • Fever

  • Flank or abdominal pain

  • Costovertebral angle tenderness

  • Nausea/vomiting

Significant bacteriuria in a catheterized or recently (≤48 hours) catheterized patient with symptoms/signs referable to the urinary tract and no other source of infection

Symptoms tend to be non-specific including:

  • Fever

  • Altered mental status

  • Lethargy

  • Acute hematuria

  • Pelvic pain

Urine culture should be obtained from newly placed or recently replaced urinary catheter

  • ≥1,000 cfu/mL of ≥1 bacteria
  • IV Antibiotics or Broad-spectrum antibiotics (FQ, amox/clav, ceftriaxone) in the previous 90 days

  • Hospitalized for >2 days in the previous 90 days

  • Current hospitalization for >5 days prior to UTI symptom onset

  • History of nosocomial or drug-resistant pathogen (ESBL) in the previous 12 months

  • Genitourinary procedure within the previous 30 days


Positive UA meets the following criteria:

  • WBC ≥ 10, PLUS
  • <2 squamous epithelial cells (>2 indicates contamination and UA should be repeated)

Criteria for UA to Reflex for Urine Culture (if urinalysis presents with any of the following, a culture & sensitivity will be performed):

  • Leukocyte Esterase: Trace, 1+, 2+, 3+;
  • Nitrite: Positive;
  • Bacteria or Yeast: Greater than 1+

Majority of UTI have culture with >100,000 CFU/mL of a single bacteria


  • Bacteria introduced to urine during collection or processing; Indicated by epithelial cells >2 cells/hpf in urinalysis
  • Contaminated specimen does not warrant treatment


  • Presence of bacteria in the urine without causing any illness
  • Asymptomatic condition

May be helpful to rule out alternative diagnosis like kidney stone or malignancy


  1. Nicolle LE, et al. Clinical Practice Guideline for the Management of Asymptomatic Bacteriuria: 2019 Update by the Infectious Diseases Society of America. Clinical Infectious Diseases. 2019;68(10):e83-e110,
  2. Gupta K, et al. 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, Clinical Infectious Diseases. 2011;52(5): e103–120,
  3. Hooton TM, et al. Diagnosis, Prevention, and Treatment of Catheter-Associated Urinary Tract Infection in Adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America, Clinical Infectious Diseases, Volume 50, Issue 5, 1 March 2010, Pages 625–663,