Antibiotics for the urinary tract are not indicated if other localizing symptoms are present

If a urinalysis and culture are obtained, remember the presence of bacteriuria or pyuria alone does not differentiate between CA-UTI and CA-ASB.

PEARL – ~100% of patients with indwelling catheters for >30 days will be colonized and bacteriuric (IDSA 2009 CA-UTI guidelines). In the absence of symptoms, this does not indicate a CA-UTI and often represents asymptomatic bacteriuria. However, the absence of bacteria or pyuria effectively rules out a UTI.

Pursue further evaluation and treatment of localizing symptoms

Reevaluate suspicion for UTI if:

• new symptoms arise
• existing symptoms do not resolve
• no etiology for symptoms is found after comprehensive evaluation

If in hospital or long-term care, implement active monitoring. For example:

• Trend vital signs every 8-12 hours
• Monitor hydration status, encourage fluids by mouth
• Repeat physical assessments by hospital or nursing home staff