Treatment Notes

The diagnosis of a UTI in inpatients can be difficult.

Signs and symptoms, the presence of a urinary catheter, and the quality of specimen collection must be considered before initiation of treatment.

Collection of cultures in the absence of signs and symptoms should be avoided.

Narrow coverage based on susceptibilities.

Sterile pyuria (positive U/A, but negative culture results) typically requires no treatment, although if the patient has received antibiotics, the patient may still have a UTI. If sterile pyuria persists consider other causes (e.g., interstitial nephritis or cystitis, fastidious organisms such as TB).

Follow-up urine cultures or U/A are only warranted for ongoing symptoms. They should NOT be acquired routinely to monitor response to therapy.