Urinary Tract Infection

A positive urine result is not synonymous with a urinary tract infection. The clinical task is to identify the syndrome first: symptomatic lower-tract infection, upper-tract or systemic infection, asymptomatic bacteriuria, or a non-urinary cause of symptoms. For a straightforward presentation, a non-pregnant, non-catheterized adult woman with new internal dysuria, frequency or urgency and no fever, rigors, flank pain or vomiting can usually be diagnosed clinically and treated empirically. The approach changes when pregnancy, male sex, a catheter, recurrent infection, urologic abnormality, recent instrumentation, immunosuppression or treatment failure is present. These patients need a more deliberate assessment and usually a urine culture. The safest prescribing decision combines the syndrome with local antimicrobial resistance data, allergy history, pregnancy status, renal function, recent antibiotic exposure and interacting medicines. In Canada, authority to prescribe uncomplicated cystitis is provincial rather than national; an NP, RN or pharmacist must work within the authority and algorithm in force for the province and practice setting.