Spectrum: Local Antimicrobial Stewardship, for Prisma Health-Midlands

Diagnosis

Prior to Initiating Antibiotics

Patients with recurrent infections, urologic abnormalities, pregnancy, and males

Obtain urinalysis and urine culture

All patients in the emergency room or hospital with acute pyelonephritis

Obtain urinalysis, urine culture, and blood cultures

Patients with indwelling catheters in place for >2 weeks from onset of symptoms

  • Catheter should be replaced prior to obtaining urinalysis and urine culture

  • If possible, discontinue catheter and obtain a culture of a voided midstream urine specimen

Patients with Non-Specific Symptoms

Change in urine color, odor, or turbidity are typically due to dehydration and not indicators for urinalysis or urine culture

Behavioral changes including worsening mental or functional status do not on their own indicate a urinary tract infection

  • These patients should be monitored and encouraged to have increased fluid intake, if possible

  • Other causes of mental status change should be assessed including constipation, dehydration, electrolyte abnormalities, medications (e.g. narcotics, etc.), liver failure, renal failure, blood sugar issues, sleep deprivation, stroke, and other infections

Notes

Consider imaging in males and patients with recurrent urinary infections

Presence of pyuria on urinalysis without symptoms does not indicate a urinary tract infection

Absence of pyuria is indicative that a urinary tract infections is not present with the exception of acute pyelonephritis with complete uretic obstruction

Urine cultures should not be done after treatment of cystitis or pyelonephritis to document cure