Pearl: A non catheter associated UTI is defined as the presence of signs or symptoms compatible with UTI and significant bacteriuria* with no more than 2 species.
*“Significant” bacteriuria varies and is arbitrary. Cutoffs of 100+ colony forming units for in-and-out catheterization and >100,000+ colony forming units in a midstream have been proposed.  Ultimately, a higher colony forming unit cutoff makes it less likely to be the result of but does not identify who is more likely to become ill or to benefit from antibiotic treatment.

Resolution:

• Patients should improve in 48-72 hours.
• Failure to improve should prompt evaluation for complicating factors (obstruction, instrumentation, impaired voiding, metabolic abnormalities, immunocompromised states)
• Consider further evaluation such as CT A/P or renal US to rule out or evaluate for perinephric abscess
• Deescalate/narrow antibiotics based on susceptibilities from urine culture

Prophylaxis:

• Vaginal estrogen: Evidence suggests estrogen can reduce UTIs and atrophic vaginitis that mimics symptoms of UTI.
• Physical activity/mobility: Higher activity is associated with reduced UTIs, but unclear if also activity can prevent UTIs.
• Systemic antibiotics: It may reduce rate of UTIs. However, increases MDR organisms, medication side effects, as well as other harms. Use is not recommended.
• Methenamine salt: Current evidence does not support the use.
• Cranberry products: Current evidence does not support the use.