Diagnosis of UTI requires a combination of reliable clinical signs and symptoms and a positive urine culture.
Do not send urine for culture or perform urine dipstick testing in patients who are asymptomatic.
Cloudy or foul smelling urine is NOT an indication for urinalysis or urine culture.
Pyuria in an asymptomatic patient is not an indication for antibiotic treatment.
There is no evidence that antibiotic therapy of asymptomatic bacteriuria is of any benefit except:
Prior to genitourinary procedures in which mucosal bleeding/trauma is expected
In pregnancy
Asymptomatic bacteriuria (abnormal urinalysis or urine culture without signs/symptoms of UTI) in the institutionalized elderly is common. Antibiotic therapy in these cases offers no benefit and increases harm. (e.g. side effects from antibiotics, antibiotic resistance, Clostridium difficile infection).
Empiric therapy for UTI can be considered if the patient has clinical signs and symptoms consistent with a UTI and appropriate urine specimens (midstream or in/out catheter) have been obtained and sent for urinalysis and culture.
Cloudy or foul smelling urine is NOT an indication for urine culture.
Pyuria in an asymptomatic patient is not an indication for antibiotic treatment.
Delirium or change in behaviour is not specific and warrants investigation for an underlying cause. UTI should not be an automatic presumptive diagnosis.
Guidelines