Pearl: CA-UTI is defined as the presence of a urinary catheter for 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)
*“Significant” bacteriuria varies and is arbitrary.  A higher cutoff makes it less likely to be the result of contamination. Per 2009 IDSA CA-UTI guidelines, “a quantitative count of greater than or equal to 1,000 colony forming units for symptomatic persons… is recommended as representing significant bacteriuria, because this threshold is a reasonable compromise between sensitivity in detecting CA-UTI and feasibility for the microbiology laboratory [minimum detection] in quantifying organisms.”

1. Determine prostatitis/GU infection in men. Prostatitis, epididymitis, and epididymo-orchitis have different duration of therapy and antibiotic selection based on bioavailability. That is outside the scope of this guide. See NEJM
2. Encourage hydration
3. Review prior sensitivities for empiric antibiotics or local antibiogram
4. Starting antibiotics
   • See antibiotic selection guide
   • Duration of therapy (per 2009 IDSA CA-UTI guidelines):
     • 7 days of therapy if prompt response, otherwise 10-14 days
     • Although not, could do 5 days of levofloxacin if used (but not for other fluoroquinolones)
     • (For women younger than 65 without upper urinary symptoms and catheter removed, can consider a three-day regimen – but why would you be using GeriGuides for that youngster?)