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Urinary Tract Infection (UTI) & Recurrent UTI


Urinary tract infections (UTIs) are common infections. In order to avoid misdiagnosis of UTI and the subsequent overtreatment / misuse of antibiotics please adhere to the following principles when using dipsticks.

About the Use of Dipsticks to Diagnose UTI

No patient over 65 years old of any sex should have a dipstick done for any reason for the diagnosis of UTI

Women under 65 years old should only have dipstick if required after:

  • Excluding  vaginal and urethral causes of urinary symptoms AND
  • Patient should have at least one of the 3 key diagnostic signs/symptoms of dysuria (burning sensation on passing urine),NEW nocturia and urine cloudy to the naked eye.

Please refer to the RCGP flow chart copied below and in full version in links on right

MSU should be be sent but dipstick NOT performed when patient presenting with UTI symptoms is:
  • Male
  • Over 65 (male or female)
Guidelines for diagnosis and treatment of UTI in catheterised patients
  • Look for systemic symptoms when suspecting UTI: pyrexia >38, hypotension, new or increased confusion, loss of diabetic control
  • Collect catheter specimen CSU appropriately.
  • NO DIPSTICK is necessary as this will usually be positive regardless of UTI.
  • Send specimen to lab, labelling clearly that this is a CSU specimen and treat empirically for UTI

NB: Bacteriuria is an inevitable consequence of long term (>5days) catheterisation. Unless the patient has symptoms of infection, do not send a specimen.

Recurrent UTI

3 or more proven UTIs within 12 months should be referred to Urology

Recurrent UTI with Urease producing bacteria eg Klebsiella, Proteus mirabilis should be referred to Urology due to increased risk of forming Staghorn Calculi

Persistent microscopic haematuria in over 50s

Should be referred via the 2WW pathway to urology


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