Lucas Schulz1, Robert J Hoffman2, Jeffrey Pothof3, Barry Fox4. 1. Infectious Diseases and Critical Care Clinical Pharmacy, University of Wisconsin Hospital and Clinics, Madison, Wisconsin. 2. Hospital Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin. 3. Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin. 4. Infectious Diseases, University of Wisconsin School of Medicine and Public Health, Clinical Science Center, Madison, Wisconsin.
Abstract
BACKGROUND: Urinary tract infections (UTI) are the most common type of infection in the United States. A Centers for Disease Control and Prevention report in March 2014 regarding antibiotic use in hospitals reported "UTI" treatment was avoidable at least 39% of the time. The accurate diagnosis and treatment of UTI plays an important role in cost-effective medical care and appropriate antimicrobial utilization. OBJECTIVE: We summarize the most common misperceptions of UTI that result in extraneous testing and excessive antimicrobial treatment. We present 10 myths associated with the diagnosis and treatment of UTI and succinctly review the literature pertaining to each myth. We explore the myths associated with pyuria, asymptomatic bacteriuria, candiduria, and the elderly and catheterized patients. We attempt to give guidance for clinicians facing these clinical scenarios. DISCUSSION: From our ambulatory, emergency department, and hospital experiences, patients often have urine cultures ordered without an appropriate indication, or receive unnecessary antibiotic therapy due to over-interpretation of the urinalysis. CONCLUSIONS: Asymptomatic bacteriuria is common in all age groups and is frequently over-treated. A UTI diagnosis should be based on a combination of clinical symptoms with supportive laboratory information. This review will assist providers in navigating common pitfalls in the diagnosis of UTI.
BACKGROUND:Urinary tract infections (UTI) are the most common type of infection in the United States. A Centers for Disease Control and Prevention report in March 2014 regarding antibiotic use in hospitals reported "UTI" treatment was avoidable at least 39% of the time. The accurate diagnosis and treatment of UTI plays an important role in cost-effective medical care and appropriate antimicrobial utilization. OBJECTIVE: We summarize the most common misperceptions of UTI that result in extraneous testing and excessive antimicrobial treatment. We present 10 myths associated with the diagnosis and treatment of UTI and succinctly review the literature pertaining to each myth. We explore the myths associated with pyuria, asymptomatic bacteriuria, candiduria, and the elderly and catheterized patients. We attempt to give guidance for clinicians facing these clinical scenarios. DISCUSSION: From our ambulatory, emergency department, and hospital experiences, patients often have urine cultures ordered without an appropriate indication, or receive unnecessary antibiotic therapy due to over-interpretation of the urinalysis. CONCLUSIONS: Asymptomatic bacteriuria is common in all age groups and is frequently over-treated. A UTI diagnosis should be based on a combination of clinical symptoms with supportive laboratory information. This review will assist providers in navigating common pitfalls in the diagnosis of UTI.
Authors: Tony W Thrasher; Martha Rolli; Robert S Redwood; Michael J Peterson; John Schneider; Lisa Maurer; Michael D Repplinger Journal: WMJ Date: 2019-12
Authors: Michael P Wilson; Kimberly Nordstrom; Eric L Anderson; Anthony T Ng; Leslie S Zun; Jennifer M Peltzer-Jones; Michael H Allen Journal: West J Emerg Med Date: 2017-05-01
Authors: Cherryl Tryphena; Rani Diana Sahni; Sushil John; Shalini Jeyapaul; Anne George; Jasmine Helan Journal: J Family Med Prim Care Date: 2021-04-29
Authors: Robert Redwood; Mary Jo Knobloch; Daniela C Pellegrini; Matthew J Ziegler; Michael Pulia; Nasia Safdar Journal: Antimicrob Resist Infect Control Date: 2018-01-08 Impact factor: 4.887