Bacteria in the bladder is common and may show up as a positive dipstick. But if the patient is asymptomatic then it is not a urinary tract infection (UTI).
Asymptomatic bacteriuria occurs commonly in:
- over 65-year-olds
- catheterised or institutionalised patients
- sexually active women
- diabetics.
Do not treat asymptomatic bacteriuria with antibiotics in non-pregnant women of any age. Pregnancy is different so seek local guidance.
Symptoms that are highly suggestive of UTI can be treated without doing any further tests. A urine culture is useful when the choice of antibiotic is not clear or there is diagnostic uncertainty. Symptoms of UTI with persistent negative midstream urine warrants further exploration for conditions such as interstitial cystitis or malignancy.
In patients unable to report symptoms a urinalysis may be helpful. The dipstick testing is very sensitive but not very specific for detecting a UTI. If positive for either nitrites or leukocytes, the probability of a UTI increases to about 80%.1
This Gem has been checked by Dr Chris Cameron, Geriatrician.
Reference
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