Rothe et al reported an algorithm for detection of a urinary tract infection (UTI) in a hospitalized patient with bacteriuria. This can help guide patient management. The authors are from multiple institutions in Germany, Japan and London.
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
Diagnosis |
Criteria |
asymptomatic bacteriuria |
3FS negative |
definitive SUTI |
3FS positive; procalcitonin >= 0.25 ng/mL; positive blood culture; blood and urine cultures concordant |
probable SUTI |
3FS positive; procalcitonin >= 0.25 ng/mL; negative blood culture; F1+F2>=1; F3=1 |
probable SUTI |
3FS positive; procalcitonin < 0.25 ng/mL; F1+F2>=1; F3=1 |
possible SUTI |
3FS positive; procalcitonin >= 0.25 ng/mL; negative blood culture; F1+F2>=1; F3=0 |
possible SUTI |
3FS positive; procalcitonin < 0.25 ng/mL; F1+F2>=1; F3=0 |
asymptomatic bacteriuria AND alternative focus |
3FS positive; procalcitonin >= 0.25 ng/mL; positive blood culture; blood and urine cultures discordant; F3=0 |
urocystitis and alternative focus |
3FS positive; procalcitonin >= 0.25 ng/mL; positive blood culture; blood and urine cultures discordant; F3=1 |
urocystitis |
3FS positive; procalcitonin>= 0.25 ng/mL; negative blood culture; F1=0, F2=0, F3=1 |
urocystitis |
3FS positive; procalcitonin < 0.25 ng/mL; F1=0, F2=0, F3=1 |
alternative or additional focus |
3FS positive; evidence of infection elsewhere |
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.
Specialty: Infectious Diseases