Parameters:
(1) temperature rise
(2) signs and symptoms of a non-urinary tract infection
(3) presence of a urinary catheter
(4) symptoms of urinary tract infection
(5) additional symptoms of pyelonephritis or urosepsis
Criteria for a temperature rise - one or both of the following:
(1) > 37.9°C (> 100°F) on >= 2 occasions over past 12 hours
(2) increased in temperature > 1.5°C (2.4°F) over baseline on >= 2 occasions over past 23 hours
Criteria for a non-urinary tract infection - 2 or more signs and symptoms:
(1) respiratory tract (dyspnea, increased cough, increased sputum production, new pleuritic chest pain)
(2) gastrointestinal system (nausea, vomiting, new abdominal pain, new onset diarrhea)
(3) skin and soft tissue (new erythema, warmth, swelling, purulent drainage)
Urinary tract signs and symptoms (List A):
(1) dysuria or burning on urination
(2) urinary catheter
(3) urgency
(4) flank pain
(5) shaking chills
(6) urinary incontinence
(7) frequency
(8) gross hematuria
(9) suprapubic pain
Signs or symptoms of pyelonephritis or urosepsis (List B):
(1) new costovertebral tenderness
(2) rigors
(3) new onset of delirium
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Rules
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Action
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temperature rise, evidence of non-urinary tract infection
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do not order urine culture
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temperature rise, 1 or more urinary tract signs and symptoms (List A)
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order urine culture
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no temperature rise, urinary catheter, and >=1 signs or symptoms of pyelonephritis or urosepsis (List B)
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order a urine culture
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no temperature rise, no urinary catheter, dysuria or burning on urination
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order a urine culture
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no temperature rise, no urinary catheter, >= 2 urinary signs and symptoms (excluding dysuria or catheter, including items 3 to 9 in List A)
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order a urine culture
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none of the above
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do not order a urine culture
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where:
• A situation may arise when a person may have a urinary tract infection and a non-urinary tract infection.
