Breakpoints #98 – Uncomplicated UTIs: Getting Uncomfortable with Uncertainty
May 24, 2024
Experts in infectious diseases and UTIs discuss challenges in diagnosis, urine analysis nuances, white blood cell thresholds, 'pill in the pocket' strategy, evolving landscape of uncomplicated vs. complicated UTIs, new antibiotics, and diagnostic uncertainties in UTI treatment.
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Urinalysis Is Diagnostic Illusion
- Urinalysis helps exclude urinary tract infections (UTI) but has limited positive predictive value for diagnosis.
- Presence of pyuria and nitrites is common without infection, especially in older or device-using populations.
Reflex Culture and Nurse Education
- Implement reflex urine culture protocols using white blood cell thresholds to reduce unnecessary culturing.
- Educate nurses as frontline gatekeepers to improve appropriate urine testing and decrease overtreatment.
UTI as a Spectrum, Not Binary
- UTI diagnosis is clinical, but traditional binary approaches overlook nuanced categories like lower urinary tract symptoms (LUTS) and bacteria of unclear significance (BUS).
- A proposed "continuum of UTI" better captures the spectrum from no infection to complicated UTI.