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Urinary tract infection (lower) - women - Making a diagnosis
How do I know my patient has it?

  • Cystitis can be confidently diagnosed when:
  • A definite diagnosis cannot always be made immediately because the symptoms and signs of cystitis are not always typical, urine dipstick tests provide only a rough guide (especially for excluding UTI), and urine culture results are not available for a few days. In this situation the decision to start empirical treatment with an antibiotic is based on a risk assessment.
  • Accurate diagnosis of UTI can be particularly difficult if the woman is frail and elderly, is institutionalized, or has a long-term indwelling urinary catheter. Diagnosis is difficult because in these situations bacteriuria is often present but is not related to the symptoms and signs.
    • In these situations, diagnose UTI using clinical judgement after looking for [SIGN, 2006]:
      • Changes in symptoms and signs.
      • Fever.
      • New or worsening urinary incontinence.
      • Signs of irritation of the urinary tract (suprapubic discomfort, and flank or loin tenderness).
      • Signs of septicaemia and generalized illness (for example, nausea, vomiting, rigors, new or increasing malaise and confusion, tachycardia, tachypnoea, poor peripheral circulation, reduced urine output, low blood pressure).
      • Features of other conditions and infections that could cause the current symptoms and signs.

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