Common errors in diagnosis and management of urinary tract infection. II: Clinical management
Abstract
Current treatment strategies in urinary tract infection (UTI) have been covered in the comprehensive reviews of Meyrier [1], Kim and Schaeffer [2], Kunin [3], Nicolle [4], Stamm and Hooton [5]. Appropriate management strategies designed for specific groups of patients with UTI can maximize therapeutic benefit while reducing cost and incidence of adverse reactions. Urine analysis is a prerequisite whenever UTI is suspected. The quality of urine analysis and diagnosis is as good as the care taken to obtain adequate urine samples. Common errors in diagnosis and classification of UTI have been discussed in a preceding article [6]. Traditionally the site of infection, i.e. lower or upper urinary tract, is diagnosed on the basis of clinical signs and symptoms, which may be quite inaccurate, however. Early reports [7] documented that 50% of women with asymptomatic bacteriuria and a significant proportion of women with symptoms primarily related to bladder infection actually had upper UTI. Conversely, one-third of patients experienced typical symptoms of acute pyelonephritis although bacteria were demonstrable in the bladder only [8]. With the introduction of techniques to localize the site of infection more accurately, it was recognized that progressive renal damage rarely if ever occurs in uncomplicated UTI, even when renal involvement is present. Nevertheless it is useful to distinguish between upper and lower UTI because treatment differs. The question arises whether…
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