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Urgent Care Diagnosis and Management of Urinary Tract Infections in Adults
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Publication Date: September 2022 (Volume 1, Number 6)

CME Credits: 4 AMA PRA Category 1 Credits™. CME expires 09/01/2025.

Specialty CME: Included as part of the 4 credits, this CME activity is eligible for 3 Pharmacology CME credits, subject to your state and institutional requirements.

Editor-in-Chief & Update Author

Keith A. Pochick, MD, FACEP
Attending Physician, Urgent Care, Charlotte, NC

Urgent Care Peer Reviewer

Cesar Mora Jaramillo, MD, FAAFP, FCUCM
Associate Medical Director of Express at Providence Community Health Centers; Clinical Assistant Professor, Department of Family Medicine; Brown University; Providence, RI

Pharmacology Peer Reviewer

Aimee Mishler, PharmD, BCPS
Emergency Medicine Pharmacist, Program Director, PGY2 EM Pharmacy Residency, Valleywise Health, Phoenix, AI

Original Authors

Jessica Best, MD
Department of Emergency Medicine, University of Texas Southwestern at Austin, Austin, TX
Derek Ou, MD
Department of Emergency Medicine, University Medical Center Brackenridge, Austin, TX
Andrew David Kitlowski, MD
Department of Emergency Medicine, University of Texas Southwestern at Austin, Austin, TX
John Bedolla, MD
Department of Emergency Medicine, University of Texas Southwestern at Austin, Austin, TX

Original Peer Reviewers

Lauren Grossman, MD, SM
First Choice ER, Arvada, CO
Nicole Lazarciuc, MD, MPH
Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY

Case Presentations

CASE 1
A 21-year-old woman presents to UC with dysuria…
  • She describes 3 days of dysuria and urgency. She also reports mild suprapubic pain.
  • Before prescribing antibiotics, you decide to ask the patient if she is experiencing any gynecologic symptoms...
CASE 2
A 38-year-old woman presents to UC with a persistent fever after a recent UTI, despite being on her second course of antibiotics…
  • She complains of nagging left-sided back pain.
  • The patient is afebrile after taking ibuprofen prior to arrival. She is well appearing and her vital signs are normal except for slight tachycardia. Her history includes kidney stones and a tubal ligation.
  • You consider antibiotic resistance, but wonder if there is more going on here…
CASE 3
A 23-year-old woman arrives in the UC clinic with fever, left flank pain, and recent dysuria...
  • The patient denies any previous medical problems and has no other complaints.
  • She is afebrile and her heart rate is 90 beats/min.
  • She has slight costovertebral angle tenderness on the left.
  • You suspect UTI, but wonder if you should have concern for something else…

How would you manage these patients? Subscribe for evidence-based best practices and to discover the outcomes.

Introduction

Urinary tract infections (UTIs) represent a heterogeneous group of disorders involving infection of all or part of the urinary tract. In the United States, UTIs result in more than 10 million outpatient healthcare encounters and approximately 1 million emergency department (ED) visits each year.1 Females are much more commonly affected than males. While the diagnosis and treatment of UTIs may seem like routine tasks for urgent care (UC) clinicians, effective management of the full spectrum of urinary tract conditions and their mimics presents a variety of challenges. Proper management of UTIs will decrease treatment failures, bouncebacks, and complications. By being familiar with atypical presentations and knowing when more extensive workup is indicated, clinicians can optimize outcomes and minimize errors in the management of UTI.

UTIs are divided into those involving the lower tract and those involving the upper tract. Lower tract infection is confined primarily to the urinary bladder and is termed cystitis. Infection of the upper urinary tract is termed pyelonephritis and indicates involvement of the kidney and ureter. Pyelonephritis is characteristically more severe than cystitis, and patients with pyelonephritis frequently have systemic symptoms and appear more ill.

UTIs are also classified as uncomplicated versus complicated. This classification is not specifically anatomic or physiologic, but more generally attempts to discern which patients are most likely to recover uneventfully with therapy (uncomplicated) versus patients who are at an increased risk of treatment failure (complicated). Patient comorbidities are the primary determinants of whether a UTI is complicated versus uncomplicated.2

The frequency and relatively benign course of most UTIs may lull UC clinicians into the false perception that these are always simple cases. While most UTIs are straightforward to diagnose, patient comorbidities, local bacterial susceptibility patterns, and available antibiotic choices and costs must be considered to ensure an optimal outcome.

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