Surveillance definitions for urinary tract infections (UTI)
Criteria | Comments |
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A. For residents without an indwelling catheter (both criteria 1 and 2 must be present) 1. At least 1 of the following sign or symptom subcriteria a. Acute dysuria or acute pain, swelling, or tenderness of the testes, epididymis, or prostate b. Fever i. Acute costovertebral angle pain or tenderness ii. Suprapubic pain iii. Gross hematuria iv. New or marked increase in incontinence v. New or marked increase in urgency vi. New or marked increase in frequency c. In the absence of fever or leukocytosis, then 2 or more of the following localizing urinary tract subcriteria i. Suprapubic pain ii. Gross hematuria iii. New or marked increase in incontinence iv. New or marked increase in urgency v. New or marked increase in frequency |
UTI should be diagnosed when there are localizing genitourinary signs and symptoms and a positive urine culture result. A diagnosis of UTI can be made without localizing symptoms if a blood culture isolate is the same as the organism isolated from the urine and there is no alternate site of infection. In the absence of a clear alternate source of infection, fever or rigors with a positive urine culture result in the noncatheterized resident or acute confusion in the catheterized resident will often be treated as UTI. However, evidence suggests that most of these episodes are likely not due to infection of a urinary source. |
2. One of the following microbiologic subcriteria a. At least 105 cfu/mL of no more than 2 species of microorganisms in a voided urine sample b. At least 102 cfu/mL of any number of organisms in a specimen collected by in-and-out catheter |
Urine specimens for culture should be processed as soon as possible, preferably within 1-2 h. If urine specimens cannot be processed within 30 min of collection, they should be refrigerated. Refrigerated specimens should be cultured within 24 h. |
B. For residents with an indwelling catheter (both criteria 1 and 2 must be present) 1. At least 1 of the following sign or symptom subcriteria a. Fever, rigors, or new-onset hypotension, with no alternate site of infection b. Either acute change in mental status or acute functional decline, with no alternate diagnosis and leukocytosis c. New-onset suprapubic pain or costovertebral angle pain or tenderness d. Purulent discharge from around the catheter or acute pain, swelling, or tenderness of the testes, epididymis, or prostate |
Recent catheter trauma, catheter obstruction, or new-onset hematuria are useful localizing signs that are consistent with UTI but are not necessary for diagnosis. |
2. Urinary catheter specimen culture with at least 105 cfu/mL of any organism (s) | Urinary catheter specimens for culture should be collected following replacement of the catheter (if current catheter has been in place for >14 d). |
Pyuria does not differentiate symptomatic UTI from asymptomatic bacteriuria. Absence of pyuria in diagnostic tests excludes symptomatic UTI in residents of long-term care facilities. cfu, colony-forming units.
*Fever: Single oral temperature >37.8℃ (>100°F) OR Repeated oral temperatures >37.2℃ (99°F) or rectal temperatures >37.5℃ (99.5°F) OR Single temperature >1.1℃ (2°F) over baseline from any site (oral, tympanic, axillary).
** Leukocytosis: Neutrophilia (>14,000 leukocytes/mm3) OR Left shift (>6% bands or ≥1,500 bands/mm3).