[CK] Dx. OF UTI

Diagnosis — The diagnosis of acute complicated UTI is made in the following clinical scenarios:

●Symptoms of cystitis (dysuria, urinary urgency, and/or urinary frequency) along with fever (>99.9ºF/37.7ºC) or other signs or symptoms of systemic illness, such as chills, rigors, or acute mental status changes. In such cases, pyuria and bacteriuria support the diagnosis.

●Flank pain and/or costovertebral angle tenderness in the setting of pyuria and bacteriuria. This is suggestive of pyelonephritis. Fever and typical symptoms of cystitis are usually present, but their absence does not rule out the diagnosis. CT findings that support the diagnosis include low attenuation extending to the renal capsule on contrast enhancement with or without swelling and complications such as renal abscesses. However, a normal CT does not rule out the possibility of mild pyelonephritis.

●Fever or sepsis without localizing symptoms in the setting of pyuria and bacteriuria may be attributed to UTI if other causes have been ruled out. Careful clinical assessment is necessary. The diagnosis of acute complicated UTI is unlikely if pyuria is absent.

The presence of bacteriuria (≥105 colony-forming units/mL of a uropathogen) with or without pyuria in the absence of any symptom that could be attributable to a UTI is called asymptomatic bacteriuria and generally does not warrant treatment in nonpregnant patients who are not undergoing urologic surgery. (See "Approach to the adult with asymptomatic bacteriuria".)

The diagnosis of UTI in a patient with an indwelling urinary catheter is discussed in further detail elsewhere. (See "Catheter-associated urinary tract infection in adults", section on 'Diagnosis'.)

The diagnosis of bacterial prostatitis in men, which can present with similar symptoms as complicated UTI, is discussed separately. (See "Acute bacterial prostatitis", section on 'Diagnosis' and "Chronic bacterial prostatitis", section on 'Diagnosis'.)

Sx or fever or sepsis.