Proud to be a NURSE ANTIBIOTIC Should I Collect Urine for Bacterial Culture? STEWARD Algorithm for Inpatients with or without a Urethral Catheter*

Developed by The Johns Hopkins Hospital Department of Antimicrobial Stewardship

START HERE  Does the patient have any of the following symptoms Does the patient have any of the that may suggest urinary tract infection? following signs present?  Burning sensation with urination NO/CAN’T  Fever or rigors GIVE HISTORY  Suprapubic or flank pain  New hematuria not related to  Frequent urination or urinary urgency catheter insertion  Acute urinary retention  Clinical instability (e.g., hypotension, tachycardia, diaphoresis) YES YES NO

Could a non-UTI diagnosis explain the signs and symptoms? Do not collect urine, communicate  Frequency/incontinence: diuretic treatment or urinary incontinence at baseline with ordering provider  Fever: known or suspected alternative source of infection (e.g., fever and O2 requirements suggest pneumonia; do not send urine) OR non-infectious cause of Do not collect a urine specimen for fever (e.g., post-op fever within 48 hours does not usually require workup) bacterial culture for:  New hematuria: trauma due to recent urethral catheter placement  Isolated dark, cloudy urine

Yes  Isolated foul-smelling urine YES NO  Pyuria in asymptomatic patients  Bacteriuria in asymptomatic  Bacteriuria in asymptomatic Is there a urine culture pending or Do not collect urine, patients resulted within last 48hrs that was sent communicate with ordering provider to work up urinary symptoms?  After treatment to document cure  “Weakness”  Falls YES NO  History of UTI  Routine on admission *This algorithm does NOT apply to patients Do not collect urine,  After urethral catheter change with neurogenic bladder, pregnant women Collect urine for communicate with  Mental status changes without or patients undergoing urologic procedures culture evidence of systemic infection or where mucosal bleeding is expected ordering provider UTI symptoms

Nicolle et al., Clinical Practice Guideline for the Management of Asymptomatic Bacteriuria: 2019 Update by the Infectious Diseases Society of America