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Advances and Challenges in the Diagnosis and Treatment of Urinary Tract Infections: the Need for Diagnostic Stewardship

  • Healthcare Associated Infections (G Bearman and D Morgan, Section Editors)
  • Published:
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Abstract

Purpose of Review

Urinary tract infections (UTIs), including catheter-associated UTIs, are among the most common bacterial infections in both inpatient and outpatient settings. Diagnosis of true UTI remains a clinical challenge, and excessive antimicrobial treatment of asymptomatic bacteriuria (ASB) or contaminated urine cultures is common.

Recent Findings

Challenges with the appropriate diagnosis of UTIs include the lack of specific signs and symptoms, no definitive diagnostic criteria, high incidence of ASB, contamination of samples, and frequent lack of indications for ordering urine cultures. Promising interventions include education and feedback, indication requirements when ordering cultures, and use of reflex culture policies that limit urine cultures.

Summary

Antimicrobial and diagnostic stewardship interventions can work synergistically to decrease ordering of urine cultures without clear indication and prevent excessive antimicrobial administration in patients without clearly defined UTI.

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Authors and Affiliations

  1. Infectious Diseases, Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, 20 N. Pine Street, Baltimore, MD, 21201, USA

    Kimberly C. Claeys

  2. Department of Epidemiology and Public Health, University of Maryland School of Medicine, 685 W. Baltimore Street, Baltimore, MD, 21201, USA

    Natalia Blanco, Daniel J. Morgan & Surbhi Leekha

  3. Department of Pathology and Laboratory Medicine, Lewis Katz School of Medicine at Temple University, 3500 N. Broad St, Philadelphia, PA, 19140, USA

    Kaede V. Sullivan

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  1. Kimberly C. Claeys
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Correspondence to Kaede V. Sullivan.

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Conflict of Interest

Kimberly C. Claeys receives personal fees from Luminex Corporation.

Natalia Blanco declares no conflict of interest.

Daniel J. Morgan reports grants from CDC, NIH, AHRQ, and VA HSRD and receives travel expenses from IDSA and SHEA.

Surbhi Leekha reports grants from CDC and AHRQ.

Kaede Sullivan declares no conflict of interest.

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Claeys, K.C., Blanco, N., Morgan, D.J. et al. Advances and Challenges in the Diagnosis and Treatment of Urinary Tract Infections: the Need for Diagnostic Stewardship. Curr Infect Dis Rep 21, 11 (2019). https://doi.org/10.1007/s11908-019-0668-7

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