Proposing the ‘Continuum of Urinary Tract Infection (UTI)’ for a Nuanced Approach to Diagnosis and Management of UTIs
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5 2024
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Source: J Urol. 211(5):690-698
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Alternative Title:J Urol
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Description:Purpose:
Patients with suspected urinary tract infections (UTIs) are categorized into three clinical phenotypes based on current guidelines: no UTI, asymptomatic bacteriuria (ASB), or UTI. However, all patients may not fit neatly into these groups. Our objective was to characterize clinical presentations of patients who receive urine tests using the ‘continuum of UTI’ approach.
Materials and Methods:
This was a retrospective cohort study of a random sample of adult non-catheterized inpatient and ED encounters with paired urinalysis and urine cultures from five hospitals in three states between 01/01/2017 and 12/31/2019. Trained abstractors collected clinical (e.g., symptom) and demographic data. A focus group discussion with multidisciplinary experts was conducted to define the ‘continuum of UTI’, a 5-level classification scheme that includes two new categories: lower urinary tract symptoms/other urologic symptoms (LUTS/OUS) and bacteriuria of unclear significance (BUS). The newly defined ‘continuum of UTI’ categories were compared to current UTI classification scheme.
Results:
Of 220,531 encounters, 3392 randomly selected encounters were reviewed. Based on the current classification scheme, 32.1% (n=704) had ASB and 53% (n=1614) did not have a UTI. When applying the ‘continuum of UTI’ categories, 68% of patients (n=478) with ASB were reclassified as BUS and 29% of patients (n=467) with ‘no UTI’ were reclassified to LUTS/OUS.
Conclusions:
Our data suggest the need to reframe our conceptual model of UTI vs. ASB to reflect the full spectrum of clinical presentations, acknowledge the diagnostic uncertainty faced by front line clinicians, and promote a nuanced approach to diagnosis and management of UTIs.
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Pubmed ID:38330392
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Pubmed Central ID:PMC11003824
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Supporting Files:No Additional Files