An updated clinical approach to diagnosing urinary tract infections that considers five potential phenotype categories instead of the usual three could aid clinical management and better center patient needs,The current diagnostic paradigm includes UTI , asymptomatic bacteriuria , or not UTI , but the researchers believe these categories exclude for more ambiguous clinical cases, such as patients whose bacteria counts are low but who are symptomatic, or when nonspecific symptoms make it difficult...
While current guidelines advise against treating these patients with antibiotics, the patients are often older adults with cognitive impairment or delirium, and frontline physicians may err on the side of prescribing antibiotics because of their clinical uncertainty. That treatment can lead to tension with hospital antibiotic stewardship teams that recommend withholding antibiotics for those patients.
"Some of these women are likely suffering from a UTI and may not receive treatment if clinicians focus primarily on the urine culture results," Abraham said. She pointed out the existence of other options than urine culture for better identifying UTI, such as urinary cell-free DNA or next-generation DNA testing of the urine. But she also said the 100,000 CFU/mL threshold should not be absolute.
Most of the cultures were obtained from inpatients. Nearly a third were negative for culture, while 42.1% grew at least 100,000 CFU/mL of bacteria and 17% grew mixed flora. Abraham said the addition of the BUS and LUTS/OUS categories has the potential to improve and individualize patient care. Clinicians can consider nonantibiotic therapies for the patients who had LUTS/OUS while they look into possible causes, while the BUS cases enable frontline clinicians and antibiotic stewardship teams to"meet in the middle" by monitoring those patients more closely in case symptoms worsen, she said.
UTI - Urinary Tract Infection UTI Antibiotics Hospitals Bacteria Bacterial Infection Bladder Urinary Bladder Inpatient Care Inpatient Bladder Infection Infective Cystitis White Blood Cell Count Leukocyte Count WBC Count White Count Blood Clinical Guidelines Guidelines Fever Pyrexia Febrile Response New York Urinalysis UA - Urinalysis Cognitive Impairment
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