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Urinary Tract Infection (UTI) – Diagnosing (GP information)

Please note:

To help influence reporting, it would be useful if you could please include on the request form symptoms the patient is experiencing rather than sending a request in labelled ‘Query UTI’.

Urinary Symptoms in Adult Women <65 years old do not culture routinely

In sexually active young men and women with urinary symptoms consider Chlamydia trachomatis

Urine culture in women and men > 65 years

  • Do not send urine for culture in asymptomatic elderly with positivedipsticks
  • Only send urine for culture if two or more signs of infection, especially dysuria,fever >38◦ or new incontinence
  • Do not treat asymptomatic bacteriuria in the elderly, as it is very common
  • Treating does not reduce mortality or prevent symptomatic episodes, butincreases side effects & antibiotic resistance

Urine culture in women and men with catheters

  • Do not treat asymptomatic bacteriuria in those with indwelling catheters,as bacteriuria is very common and antibiotics increase side effects andantibiotic resistance
  • Treatment does not reduce mortality or prevent symptomatic episodes, butincrease side effects and antibiotic resistance
  • Only send urine for culture in catheterised if features of symptomatic infection.However always: - exclude other sources of infection - check that the catheter drains correctly and is not blocked - consider need for continued catheterisation - if the catheter has been in place for more than 7 days, consider changing it before/when starting antibiotic treatment
  • Do not give antibiotic prophylaxis for catheter changes unless history ofsymptomatic UTIs due to catheter change

When else should I send a urine sample for culture?

  • Pregnancy – if symptomatic for investigation of possible UTI. In all at firstantenatal visit – as asymptomatic bacteriuria is associated with pyelonephritisand premature delivery
  • Suspected pyelonephritis (loin pain and fever)
  • Suspected UTI in men
  • Failed antibiotic treatment or persistent symptoms
  • Recurrent UTI, abnormalities of genitourinary tract, renal impairment –more likely to have a resistant strain

There’s more detailed information in this Quick Reference Guide for Primary Care.

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