Schwartz/Reisman Emergency Medicine Institute

UTI in the ED

Uncomplicated Urinary Tract Infections in the Emergency Department

Current guidelines do not recommend the routine use of urinary cultures to diagnose acute urinary tract infections in premenopausal, non-pregnant women unless there are complicating factors such as atypical presentation, structural abnormalities or recurrent infection/antibiotic use.

SREMI researchers recently conducted a retrospective chart review of women aged 18-39 years presenting to North York General and Mount Sinai Hospitals to determine the number of urine cultures ordered for women who presented to the emergency department (ED) with symptoms of uncomplicated UTI, and determine whether a culture result impacted subsequent management.

Of the 512 charts included in the analysis, 96.5% patients had a urinalysis, of which 93.7% had positive leukocyte esterase and 18.2% had positive nitrites. 370 patients (72.3%) had urine cultures performed, of which 63.8% were positive. 505 (98.6%) patients received antibiotics (53.9% Macrobid; 22.6% Ciprofloxacin; 15.0% Septra; 6.7% other; 1.8% not documented). Seven (1.9%) cultures grew organisms resistant to the prescribed antibiotic; two (0.5%) patients received new prescriptions.

For the majority of young female patients with uncomplicated UTI, urine cultures did not change management. However, the authors suggested when the diagnosis is uncertain based on symptomology and urinalyses alone, a urine culture may be warranted as approximately 40% patients prescribed an antibiotic did not actually have a UTI. Unnecessary treatment with antibiotics may cause exposure to multidrug resistant organisms, possible allergic reactions, and unnecessary risk to the patient.