Parameters:
(1) temperature rise (fever)
(2) presence of a urinary catheter
(3) dysuria or burning on urination
(4) symptoms of urinary tract infection
(5) additional symptoms of pyelonephritis or urosepsis
(6) results of urine culture and urinalysis
Criteria for a temperature rise - one or both of the following:
(1) > 37.9°C (> 100°F) on >= 2 occasions over past 12 ours
(2) increased in temperature > 1.5°C (2.4°F) over baseline on >= 2 occasions over past 23 hours
Urinary tract signs and symptoms (List A):
(1) urgency
(2) flank pain
(3) shaking chills
(4) urinary incontinence
(5) frequency
(6) gross hematuria
(7) suprapubic pain
Signs or symptoms of pyelonephritis or urosepsis (List B):
(1) new costovertebral tenderness
(2) rigors
(3) new onset of delirium
Results of urine culture and urinalysis:
(1) pyruria: present or absent
(2) urine culture: negative, mixed (contaminants), pending, or positive (> 10^5 CFU per mL)
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Rules
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Action
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urine culture negative or mixed
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do not treat
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urine culture positive, urinary catheter present, fever or >= 1 signs of pyelonephritis/urosepsis present (List B)
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treat with antibiotics
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urine culture positive, no urinary catheter present, dysuria present
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treat with antibiotics
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urine culture positive, no urinary catheter present, >=2 of fever and urinary tract signs/symptoms (List A)
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treat with antibiotics
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urine culture pending, urinary catheter present, fever or >= 1 signs of pyelonephritis/urosepsis present (List B)
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treat with antibiotics; stop if culture negative or no pyuria
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urine culture pending, no urinary catheter present, dysuria present
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treat with antibiotics; stop if culture negative or no pyuria
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urine culture pending, no urinary catheter present, >=2 of fever and urinary tract signs/symptoms (List A)
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treat with antibiotics; stop if culture negative or no pyuria
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none of the above
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do not treat
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where:
• The algorithm assumes that the patient has not been on antibiotics. Antibiotics can cause a false negative urine culture.
• There are some combinations of pyruria and urine cultures that may not be covered by the algorithm.
