About this episode

This episode discusses the complexities of diagnosing urinary tract infections and the implications of overtreatment with antibiotics.

Contributor: Travis Barlock, MD Educational Pearls: Foul-smelling urine and cloudy urine are commonly misinterpreted as indicators of a UTI. However, these findings alone are not diagnostic. Criteria for UTI: Presence of localized urinary symptoms: Suprapubic pain Dysuria Hesitancy Urgency Urinalysis with WBC > 10 Urine culture with > 100,000 CFU/mL Colonization differs from infection - many patients harbor asymptomatic bacteria but do not have a true infection. Consequences of overtreatment One review showed 45% of patients treated with antibiotics for a presumed UTI actually had asymptomatic bacteriuria and were incorrectly treated. Unnecessary antibiotic treatment can have deleterious effects on the gut microbiome, increasing the risk of multidrug-resistant infections. Another problem with overdiagnosing UTI is missing the real diagnosis by explaining symptoms away as "just a UTI." Be mindful of the risk of overtesting versus not testing at all. Clinicians must navigate a balance between moving patients efficiently through the ER and testing appropriately when a UTI is truly suspected. References : Baghdadi JD, Korenstein D, Pineles L, et al. Exploration of primary care…

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