Patient selection: bacteriuria
F scores (one point each):
F1: fever at triage (with rigors or chills prior to presentation)
F2: failure or dysfunction of an organ system (brain, kidney, etc)
F3: focal urinary tract infection symptoms (acute dysuria, frequency, suprapubic tenderness, costovertebral angle pain or tenderness
3FS score =
= F1 + F2 + F3
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Diagnosis
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Criteria
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asymptomatic bacteriuria
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3FS negative
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definitive SUTI
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3FS positive; procalcitonin >= 0.25 ng/mL; positive blood culture; blood and urine cultures concordant
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probable SUTI
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3FS positive; procalcitonin >= 0.25 ng/mL; negative blood culture; F1+F2>=1; F3=1
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probable SUTI
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3FS positive; procalcitonin < 0.25 ng/mL; F1+F2>=1; F3=1
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possible SUTI
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3FS positive; procalcitonin >= 0.25 ng/mL; negative blood culture; F1+F2>=1; F3=0
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possible SUTI
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3FS positive; procalcitonin < 0.25 ng/mL; F1+F2>=1; F3=0
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asymptomatic bacteriuria AND alternative focus
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3FS positive; procalcitonin >= 0.25 ng/mL; positive blood culture; blood and urine cultures discordant; F3=0
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urocystitis and alternative focus
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3FS positive; procalcitonin >= 0.25 ng/mL; positive blood culture; blood and urine cultures discordant; F3=1
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urocystitis
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3FS positive; procalcitonin>= 0.25 ng/mL; negative blood culture; F1=0, F2=0, F3=1
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urocystitis
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3FS positive; procalcitonin < 0.25 ng/mL; F1=0, F2=0, F3=1
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alternative or additional focus
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3FS positive; evidence of infection elsewhere
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where:
• SUTI = UTI with systemic involvement
Asymptomatic bacteriuria does not require treatment.
Uncomplicated urocystitis requires antibiotic therapy with activity against urinary pathogen.
Systemic infection requires more aggressive management.
