Infezioni delle vie urinarie nell'adulto - SNLG-ISS

Infezioni delle vie urinarie nell’adulto. Linea guida regionale
benefits, risks and costs, and the feasibility of the recommendation. The reasons that
determined the attribution of the grade to every single recommendation are also
reported.
The document presents some implementation experiences of UTI management published
in literature.
Finally, relevant information for women suffering from recurrent UTI and for people with
urinary catheter and their relatives is reported. Evidence table and literature search
strategies are also provided.
The guideline can be downloaded from the website of the Regional Healthcare and Social
Agency in two formats:
full guideline
quick reference guide.
The publication of leaflets for patients has also been planned.
Key messages
The diagnosis of UTI is a clinical diagnosis: it is primarily based on symptoms and
signs and should not rely exclusively on laboratory tests that detect the presence
of bacterial and white cells in urine.
Routine urine culture is not required to manage uncomplicated UTI.
There is a risk of false positive results with all tests for diagnosis of bacteriuria used
at hospital and at community level. The only reliable test is the culture of urine
obtained by needle aspiration of the bladder, that it is not routinely performed in
Emilia-Romagna.
Bacteriuria is not a disease.
Asymptomatic bacteriuria should be diagnosed and treated only in pregnant women
and before a surgery involving the urinary tract.
Fluorquinolones should not be used for treating uncomplicated UTI. They should be
used only when other options are not available, because the rate of uropathogens
resistance against fluorquinolones is increasing.
Indwelling catheters should be placed only when no other options are available.
Catheter should be removed as soon as it is no longer required.
Routine prophylactic antimicrobials should not be administered to patients at the time
of catheter replacement: they do not reduce the risk of catheter-associated UTI while
they increase the risk of developing antimicrobial resistance.
Routine urine culture or other urinary tests should not be performed in patients with
urinary catheter.
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