Urinary%20tract%20infection%20in%20women%20-%20complicated Diagnosis

• Specific questioning for the presence or absence of prior urinary infections and therapy, genitourinary surgeries, nephrolithiasis, gross hematuria, sickle cell disease and other associated disease predispositions

• Urine analysis with microscopic exam, urine culture and sensitivity testing should be performed before, during and after therapy
• A pregnancy test may be done in women of reproductive age

Significant Bacteriuria

• Women: ≥10⁵ colony forming units (cfu)/mL in midstream urine (MSU) sample or >10⁴ cfu/mL in straight catheter urine sample
• Asymptomatic patients: 2 consecutive urine samples showing ≥10⁵ cfu/mL taken at least 24 hours apart with the same bacterial species

Pyuria

• ≥10 WBC/mm³, though may not be present with an obstructed urinary collecting system
• Pyuria is not diagnostic for catheter-associated UTI in catheterized patients

Urine Dipstick

• For routine assessment including leukocyte esterase test, hemoglobin and nitrite reaction

Urine Culture and Sensitivity 

• Urine specimen for culture should be obtained prior to the administration of antibiotics
  • Urine culture is obtained in catheterized patients after the catheter has been removed 
  • Selection of antibiotic should be re-evaluated once culture results become available
• If possible, to avoid the emergence of resistant strains, therapy should be guided by urine culture

Further Work-up to Identify and Correct Anatomical, Functional or Metabolic Abnormality

• Radiologic studies are indicated to find the cause of complicated UTI
• Imaging of the urinary tract should be undertaken to evaluate for hydronephrosis, stone disease and urinary tract abnormalities
  
  • Plain abdominal radiographs may be useful to evaluate for abnormal calcifications, renal contour and gas patterns
  • Intravenous (IV) pyelogram for radiographic images of the bladder, kidneys and ureters to determine extent of urinary obstruction
  • Voiding cystourethrogram for evaluation of the neurogenic bladder and urethral diverticulum, and to determine the presence of vesicoureteral reflux
  • Renal ultrasonography is an extremely valuable tool to evaluate for hydronephrosis, pyonephrosis and perirenal abscesses
  • Computed tomography (CT) scan is more sensitive for nephrolithiasis, defining renal and suprarenal pathology
  • Cystoscopy for a convenient inspection of the urethra and the bladder