Urinalysis
UTI Myths and Misconceptions
- 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
Quick-Wee
A clinician (or parent/carer with supervision) rubs the suprapubic area of the child ( 1-12 months) in a circular pattern with gauze soaked in cold saline held with forceps until clean catch urine sample is obtained.
UTI Myths
Myth 1: The Urine Is Cloudy and Smells Bad. My Patient Has a UTI
Myth 2: The Urine Has Bacteria Present. My Patient Has a UTI. Also See Myth 8
Myth 3: My Patient’s Urine Sample Has >5 Squamous Epithelial Cells per Low-Power Field and the Culture is Positive. Because the Culture is Positive, I Can Disregard the Epithelial Cell Count and Treat the UTI
Myth 4: The Urine Has Positive Leukocyte Esterase. My Patient Should Have a Urine Culture Performed, Has a UTI, and Needs Antibiotics
Myth 5: My Patient Has Pyuria. They Must Have a UTI
Myth 6: The Urine Has Nitrates Present. My Patient Has a UTI
Myth 7: All Findings of Bacteria in a Catheterized Urine Sample Should Be Diagnosed as a UTI
Myth 8: Patients with Bacteriuria Will Progress to a UTI and Should Therefore Be Treated
Myth 9: Falls and Acute Altered Mental Status Changes in the Elderly Patient Are Usually Caused by UTI
Myth 10: The Presence of Yeast or Candida in the Urine, Especially in Patients with Indwelling Urinary Catheters, Indicates a Candida UTI and Needs to Be Treated
American Academy of Pediatrics (AAP) definition of UTI
The latest definition of UTI from the American Academy of Pediatrics (AAP) requires both a urinalysis with pyuria or bacteria and a urine culture with more than 50,000 CFU/mL.
Pee on demand: making babies pee for msu testing
Procedure:
It takes a minimum of two people to perform this procedure. However, it is better with three, one dedicated to making the catch.
- Encourage oral fluid intake.
- 25 minutes following this feed, the baby/infants genitals are cleaned thoroughly with warm soapy water and dried with sterile gauze.
- A sterile container is prepared to collect the specimen.
- Baby is held under the armpits (just above the bed) with legs dangling (the parents can easily assist with this).
- The nurse then starts bladder stimulation which consists of gentle tapping in the suprapubic area at a rate of 100 taps per minute for 30 seconds.
- Next, the lumbar paravertebral zone (think the small of the lower back) is massaged in a light circular motion for 30 seconds.
- Step 5 and six are repeated until urine is released.
Stand clear & catch the mid-stream.