Urgent Care Diagnosis and Management of Urinary Tract Infections in Adults

Points & Pearls Excerpt

• UTIs are divided into those involving the lower tract and those of the upper tract. Lower tract infection is confined primarily to the urinary bladder and is termed cystitis. Upper tract infection involves the kidney and ureter is termed pyelonephritis.
• Pyelonephritis is characteristically more severe than cystitis, and patients with pyelonephritis frequently have systemic symptoms and appear more ill.
• The classic symptoms of acute cystitis are dysuria, frequency, urgency, and suprapubic discomfort. However, these symptoms are not specific to UTIs and overlap with other entities, so patients should be asked about symptoms suggesting a UTI mimic (eg, STIs, BPH, appendicitis, or diverticulitis). Genitourinary and/or abdominal examination may be warranted, depending on the presenting symptoms.
• Both the urine dipstick and microscopic urinalysis are poor at ruling out UTI, but if there is suspicion for UTI with a negative urine dipstick, microanalysis can help rule in disease.^32,33