The Diagnosis and Treatment of Adult Urinary Tract Infections in the Emergency Department

Diagnosis and management of UTIs in the ED requires a thoughtful approach, especially given the limited amount and quality of information we are presented with, the potential for severe infection if inadequately treated, and our mandate to provide good antibiotic stewardship. Differentiating cystitis from pyelonephritis from nonurinary pathology is challenging. Emerging antibiotic resistance among uropathogens adds further complexity. Best care entails a careful history and physical examination for urinary signs and symptoms, a nuanced consideration of urine test results and their limitations, and informed judgment as to whether or not to prescribe antibiotics. Once that decision to treat has been made, empirical antibiotic selection should incorporate patient-level factors, national guidelines, and local antibiogram data.