Urinary tract infection in females

Scope

  • This guideline covers the assessment and management of adult female patients with suspected urinary tract infections.

Out of scope

  • Males
  • Children

Assessment

Signs and Symptoms

  • Females are at high risk of UTI (estimated lifetime risk is 50%).
Risk factors
  • Include:
    • Increasing age
    • Pregnancy
    • Diabetes
    • Sexual intercourse
    • Urinary tract abnormalities
    • Having an indwelling catheter
    • Living in a care home
Common symptoms
  • Dysuria
  • Frequency
  • Other possible symptoms include:
    • Polyuria
    • Suprapubic tenderness
    • Haematuria
    • Urgency

Differential Diagnoses

  • If UTI is first presentation
  • Patient has 3 or more common symptoms
  • And vaginal discharge or irritation
    • Consider other diagnosis
      • Sexually transmitted infection
      • Thrush
      • Atrophic vaginitis
      • Threadworms
      • Abacterial urethritis or cystitis

Red Flags

Haematuria - see 2WW urology guideline

Management

If UTI is a recurrence

If UTI is first presentation

Patient has 3 or more common symptoms
    • Patient does NOT have vaginal discharge or irritation
    • No dipstick is needed
    • Patient has UTI
  • Patient has symptoms of Pyelonephritis
    • Suspect Pyelonephritis if;
      • Temperature greater than 39°C
      • Rigors
      • Nausea and Vomiting
      • Diarrhoea
      • Loin pain
  • All patients to have MSU
  • No evidence of dehydration or haemodynamic instability
    • Treat as Pyelonephritis
    • Review in 24 hours
  • Evidence of dehydration or haemodynamic instability
    • Urine samples
    • Consider emergency admission
  • Patient has no symptoms of Pyelonephritis
    • Send MSU only if failure to respond to empirical treatment
    • Treat for UTI
    • Advise patient that lower UTI is usually self-limiting:
      • symptoms resolve within:
        • 4-9 days without antibiotics
        • 3-8 days with antibiotics
      • Relieve symptoms with paracetamol or ibuprofen
Patient has 2 or fewer common symptoms or vague symptoms e.g. abdominal pain
  • Obtain urine specimen
    • Urine not cloudy (91% culture negative)
      • Do not treat for UTI
      • No dipstick needed
    • Urine cloudy
      • Perform dipstick
      • All negative
        • UTI very unlikely possible urethral syndrome
      • Positive blood or protein
        • UTI unlikely consider other diagnosis
        • Red flag
      • Positive leucocyte negative nitrite
        • UTI or urethral syndrome
        • Send MSU
        • Treat if severe Or wait for culture result
        • Advise patients that lower UTI is usually self-limiting]: symptoms resolve within:
          • 4-9 days without antibiotics
          • 3-8 days with antibiotics
        • Relieve symptoms with paracetamol or ibuprofen
      • Positive nitrate
        • MSU not usually required
        • Send urine if abnormalities of genitourinary tract or renal impairment
        • Treat for UTI
        • Advise patients that lower UTI is usually self-limiting: symptoms resolve within:
          • 4-9 days without antibiotics
          • 3-8 days with antibiotics
        • Relieve symptoms with paracetamol or ibuprofen

Joint formulary – Chapter 5 – Infections

Joint formulary – Chapter 7 – urinary-tract disorders

Referral

Referral Criteria

Consider Emergency admission
  • If evidence of
    • Dehydration
    • Haemodynamic instability

Supporting Information

Pathway Group

This pathway was signed off by the NEW Devon CCG Northern Locality Clinical Pathway Group.

Publication date: May 2017

 

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