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Urinary tract infection (lower) - women - Management
When should I culture the urine of a woman with suspected cystitis?

  • Urine microscopy and culture are not routinely required for women with uncomplicated cystitis.
  • Send urine for microscopy and culture if any of the following apply:
    • There are risk factors for a complicated urinary tract infection — for example the woman has recently had urological instrumentation, or is immunocompromised, or has been in hospital recently.
    • Confirmation of the diagnosis or exclusion of other conditions is required.
    • The woman has not responded to antibiotic treatment.
    • The woman has recurrent episodes of cystitis and this has not been investigated.
      • When underlying causes of recurrent cystitis and other conditions have been excluded, it is not necessary to routinely culture the urine for further episodes.
Basis for recommendation

These recommendations are in line with Scottish Intercollegiate Guidelines Network guidelines [SIGN, 2006].

Urine culture

  • Urine culture is mainly useful for identifying bacteria and their sensitivity to antibiotics [SIGN, 2006].
  • Urine microscopy and culture are not routinely recommended for women with uncomplicated cystitis because the results are not available for immediate decision-making and, by the time they are available, most women's symptoms will be resolving. Three studies found that, if urine were to be routinely cultured for all women with acute cystitis, the average duration of symptoms would be reduced by between 0.04 and 0.32 days [SIGN, 2006]. Similar evidence is provided by a randomized controlled trial that compared different strategies for antibiotic treatment [Little et al, 2009]. An economic analysis estimated the cost of preventing 1 day of symptoms as £215, and the cost per QALY (quality adjusted life year gained) was £215,000 [SIGN, 2006].
  • Urine culture is recommended for women with a complicated infection because the risks associated with treatment failure are increased [SIGN, 2006].

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