Loeb et al developed an algorithm for when to treat a nursing home resident for a urinary tract infection. This can help reduce unnecessary antibiotic therapy. The authors are from McMaster University, the University of Toronto, and the Sunnybrook and Women's College Health Sciences Centre in Ontario, Canada.
Parameters:
(1) temperature rise (fever)
(2) presence of a urinary catheter
(3) dysuria or burning on urination
(4) symptoms of urinary tract infection
(5) additional symptoms of pyelonephritis or urosepsis
(6) results of urine culture and urinalysis
Criteria for a temperature rise - one or both of the following:
(1) > 37.9°C (> 100°F) on >= 2 occasions over past 12 ours
(2) increased in temperature > 1.5°C (2.4°F) over baseline on >= 2 occasions over past 23 hours
Urinary tract signs and symptoms (List A):
(1) urgency
(2) flank pain
(3) shaking chills
(4) urinary incontinence
(5) frequency
(6) gross hematuria
(7) suprapubic pain
Signs or symptoms of pyelonephritis or urosepsis (List B):
(1) new costovertebral tenderness
(2) rigors
(3) new onset of delirium
Results of urine culture and urinalysis:
(1) pyruria: present or absent
(2) urine culture: negative, mixed (contaminants), pending, or positive (> 10^5 CFU per mL)
|
Rules |
Action |
|
urine culture negative or mixed |
do not treat |
|
urine culture positive, urinary catheter present, fever or >= 1 signs of pyelonephritis/urosepsis present (List B) |
treat with antibiotics |
|
urine culture positive, no urinary catheter present, dysuria present |
treat with antibiotics |
|
urine culture positive, no urinary catheter present, >=2 of fever and urinary tract signs/symptoms (List A) |
treat with antibiotics |
|
urine culture pending, urinary catheter present, fever or >= 1 signs of pyelonephritis/urosepsis present (List B) |
treat with antibiotics; stop if culture negative or no pyuria |
|
urine culture pending, no urinary catheter present, dysuria present |
treat with antibiotics; stop if culture negative or no pyuria |
|
urine culture pending, no urinary catheter present, >=2 of fever and urinary tract signs/symptoms (List A) |
treat with antibiotics; stop if culture negative or no pyuria |
|
none of the above |
do not treat |
where:
• The algorithm assumes that the patient has not been on antibiotics. Antibiotics can cause a false negative urine culture.
• There are some combinations of pyruria and urine cultures that may not be covered by the algorithm.
Specialty: Infectious Diseases, Urology
ICD-10: ,
