PHE UTI Quick Reference Guide

The ‘Diagnosis of Urinary Tract Infections: Quick Reference Guide for Primary Care’ describes when to:

• send urine for culture in adults and children

• consider a UTI in adults over 65 years

• consider a UTI in women under 65 years

• consider a UTI in infants and children

The aim of the guidance is to provide a simple, effective, economical and empirical approach to the diagnosis of urinary tract infections and minimise the emergence of antibiotic resistance in the community.

Useful flowcharts are provided to aid diagnosis and offer treatment recommendations. Some important highlights from the guidance are listed below but please follow the link to read the guidance in full. The PHE UTI diagnostic flowchart for women (under 65 years) with suspected UTI suggests that having 2 or 3 of the key diagnostic symptoms/signs indicate that a UTI is likely. These are:

• dysuria (burning pain when passing urine)

• new nocturia (passing urine more often at night)

• urine cloudy to the naked eye

If just one of these symptoms is present in a woman under 65 years old with a suspected UTI, a urine dipstick should be performed. If none of these symptoms are reported but there are other related severe symptoms (such as urgency, visible haematuria, frequency or suprapubic tenderness) then a urine dipstick is also recommended.

There is an increasing amount of telephone triaging being undertaken in general practice for patients presenting with urinary symptoms. The recommended process for clinician practices is to:

1. Exclude other genitourinary causes of urinary symptoms

2. Check for new signs of pyelonephritis, systemic infection, or risk of suspected sepsis

3. In women under 65 years old use the 3 symptoms/signs which help to identify true UTIs. These 3 diagnostic features are new dysuria, new nocturia or cloudy urine. If patients have 2 or 3 of these then empirical antibiotics are recommended.

4. If women under 65 years old have none or only one out of new dysuria, new nocturia, cloudy urine, ask them to bring in a urine sample and perform urine dipstick, providing advice on taking a urine sample (morning is most reliable using a sterile container).