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Does your patient really have a UTI?
Background
How often do we test the urine of patients with no urinary symptoms? How often are we prompted to send samples for culture after a random dipstick test? How often are these patients prescribed antibiotics even when they have no clinical signs of a UTI? If your Emergency Department is anything like mine, each of these things happen quite often.
"What's the harm?" you may ask. Well, besides poor use of resources, there are the side effects of treatment, increasing antimicrobial resistance, and the risk that you miss another condition because you stop workup when a UTI is 'found'.
Like any test, you've got to know why you're running it and what you are looking for.
Suspected renal colic? Useful test
Urinary frequency, urgency, dysuria or suprapubic pain? Useful test
Abdominal pain or PV bleeding in a woman of child-bearing age? Useful test
Type 1 diabetic with abdominal pain and vomiting? Useful test
Pregnant woman with hypertension and headache? Useful test
Elderly lady who is a little more confused than usual? Actually not so useful
Gentleman who fell while getting out of the bath? Not useful
Middle-aged lady who had an episode of chest pain? No
Young chap with a cough? Oh come on!
The paper
Nicolle L, Gupta K, Bradley S. Clinical practice guideline for the management of asymptomatic bacteriuria: 2019 update by the Infectious Diseases Society of America. Clin Infect Dis. March 2019 [Epub ahead of print][1]
For detailed show notes please visit our website: https://the-breach.com
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By Barrie StevensonBackground
How often do we test the urine of patients with no urinary symptoms? How often are we prompted to send samples for culture after a random dipstick test? How often are these patients prescribed antibiotics even when they have no clinical signs of a UTI? If your Emergency Department is anything like mine, each of these things happen quite often.
"What's the harm?" you may ask. Well, besides poor use of resources, there are the side effects of treatment, increasing antimicrobial resistance, and the risk that you miss another condition because you stop workup when a UTI is 'found'.
Like any test, you've got to know why you're running it and what you are looking for.
Suspected renal colic? Useful test
Urinary frequency, urgency, dysuria or suprapubic pain? Useful test
Abdominal pain or PV bleeding in a woman of child-bearing age? Useful test
Type 1 diabetic with abdominal pain and vomiting? Useful test
Pregnant woman with hypertension and headache? Useful test
Elderly lady who is a little more confused than usual? Actually not so useful
Gentleman who fell while getting out of the bath? Not useful
Middle-aged lady who had an episode of chest pain? No
Young chap with a cough? Oh come on!
The paper
Nicolle L, Gupta K, Bradley S. Clinical practice guideline for the management of asymptomatic bacteriuria: 2019 update by the Infectious Diseases Society of America. Clin Infect Dis. March 2019 [Epub ahead of print][1]
For detailed show notes please visit our website: https://the-breach.com