Pylonephritis

• UTI is a clinical diagnosis, not a laboratory one. Dysuria plus urinary frequency in the absence of symptoms of STI is diagnostic.

• Most patients with a clinical picture consistent with a lower UTI do not require urine tests.

• The indications for urine tests for suspected lower UTI include immunocompromised patients, history of multiple courses of antimicrobial therapy, history of antibiotic resistance and history of multiple drug allergies.

• While bacteria seen on microscopy is predictive of a positive culture, it is not necessarily diagnostic of a UTI as the positive culture could represent a contaminant or asymptomatic bacteriuria.

• A common pitfall is treating non-pregnant patients with asymptomatic bacteriuria with antibiotics. Asymptomatic bacteriuria is very common in all age groups and is often misdiagnosed as a UTI.

• Do not routinely treat catheterized patients found to have pyuria or candida in their urine.

• A common pitfall is to assume that the cause of altered level of awareness in an elderly is a UTI upon finding pyuria or bacteriuria on urinalysis leading to premature closure and missing a more serious diagnosis.

• Imaging is not routinely required for patients suspected clinically of pyelonephritis.

• Cranberry juice, direction of wiping and voiding post intercourse are not effective in preventing recurrent UTIs

• 3-5 days duration of therapy is sufficient for the vast majority of lower UTI