Pearl: CA-UTI is defined as the presence of a urinary catheter within past 48 hours of symptom onset, presence of signs or symptoms compatible with UTI, absence of other infectious source, and significant bacteriuria with one or more species. (IDSA CA-UTI guidelines)

After ruling out non-UTI localizing symptoms, determine if you can attribute symptoms to the urinary tract.

Signs and symptoms of UTI – NEW OR WORSENING

• Localizing:
  • Flank pain (between epigastrium and back)
  • Costovertebral tenderness
  • Hematuria
  • Pelvic discomfort
  • Suprapubic pain/tenderness

• If bladder catheter recently removed/absent:
  • Dysuria
  • Urgency
  • Frequency

• If spinal cord injury:
  • Increased spasticity
  • Autonomic dysreflexia
  • Sense of unease

• Constitutional that may be attributable if no other etiology is found:
  • Fever
  • Rigors
  • Malaise
  • Lethargy

What is not a sign or symptom of UTI?

1. Appearance or smell of urine:
   • “Dark, cloudy, or foul-smelling urine is not sufficient to indicate a UTI and may instead reflect mild dehydration or changes to diet or medications” (JAMDA – Diagnosis of UTI)
     
2. Nonspecific symptoms (delirium, falls, behavior changes, etc):
   • “Nonspecific symptoms — including change in cognition, agitation, decreased appetite, and falls – are not symptoms of UTI, especially when genitourinary tract specific signs and symptoms are absent” (JAMDA – Role of Behavioral Change)
   • In older patients with functional and/or cognitive impairments with bacteriuria and without local genitourinary symptoms or other signs of infection (fever, hemodynamic instability) who experience delirium or a fall, we recommend assessment for other causes and careful observation rather than antimicrobial treatment.” IDSA Asymptomatic Bacteriuria Guidelines 2019 – Recommendations V1 and V2