Top Ten Myths Regarding the Diagnosis and Treatment of Urinary Tract Infections

Lucas Schulz, PHARMD; Robert J. Hoffman, MD; Jeffrey Pothof, MD; Barry Fox, MD

Disclosures

J Emerg Med. 2016;51(1):25-30. 

In This Article

Discussion

The UTI Myths

Health care providers have, over the years, adhered to dogma surrounding the diagnosis of UTI that is incorrect. This information has been perpetuated, and has caused significant overtreatment of asymptomatic bacteriuria. Common misconceptions such as color or smell have no predictive value as it pertains to the diagnosis of UTI, but are commonly utilized as "tests" to increase the posttest probability that a patient has a UTI. There also exists wide variation in the interpretation of a urinalysis between different providers. Our review demonstrates how no one test value can reliably make the diagnosis of UTI. Especially common in emergency medicine is using the diagnosis of UTI to account for an elderly patient's altered mental status. Not only is this uncommon, but this type of anchoring hinders the clinician from diagnosing the real cause of the patient's altered mental status.

Overtreatment of Asymptomatic Bacteriuria

Frequent overdiagnosis of UTI and subsequent treatment is a common problem that is perpetuated by many myths surrounding the diagnosis of UTI. This leads to unknowingly using antibiotics that have no benefit, but do carry risks. The CDC reports that nearly 40% of all antibiotics prescribed for presumed UTI could have been avoided.[1] Unfortunately, the practice of overprescribing antibiotics has generated antibiotic resistance among organisms that continue to challenge our health care systems and harm patients.[31] In addition, inappropriate antibiotic utilization increases health care costs. The National Health Expenditure Accounts Team estimates that in 2014 the United States spent $9523 per person, or 17.5% of our gross domestic product, on health care.[32]

Recommendations for Improved Accuracy When Diagnosing UTI

EDs that have implemented reflexive urine cultures based on urinalysis values should carefully evaluate whether this practice increases their treatment rate of asymptomatic bacteriuria. We believe increased education aimed at physicians, advanced practice providers, and nurses could go a long way toward disproving the common myths that frequently guide providers to make the wrong decision. There is also a role for clinical decision support built into our electronic medical records that could provide real-time assistance to providers such that it is easier to use evidence-based guidelines, and as a result, improved accuracy of the diagnosis of UTI could be ensured.

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