It is important to make an accurate diagnosis in this case as the risk of severe illness and treatment varies between an uncomplicated and a complicated UTI.1 The absent of classical presentation of loin pain and rigors would make acute pyelonephritis very unlikely. She was also haemodynamically stable on examination and showed no signs of urosepsis. Hence, based on this patient’s complaint of dysuria, frequency and suprapubic pain accompanied by urinalysis findings of leucocytes and nitrites; the most probable diagnosis is an uncomplicated UTI.
Background
UTI is one of the most common problems for which young women seek medical attention, accounting for nearly 25% of all infections.2 It is estimated that around one-third of women have had …show more content…
Her observations were normal apart from fever. Although it is fairly certain this is an uncomplicated UTI based on history and examination, one study showed that the diagnostic accuracy for UTI by relying just on clinical assessment remains unclear.8 According to the SIGN and NICE guidelines, the first line of investigation for UTI is urinalysis as this enhances diagnostic accuracy and thus, reduces the chance of prescribing unnecessary antibiotics.9-11 Further investigation was done on her by obtaining a urine sample for culture and microscopy. However, it does raise the question if these are needed to be routinely performed for all patients with UTI. Her previous episode of UTI was 8 months ago and she was treated with trimethoprim. SIGN guidelines do not routinely recommend urine microscopy and culture for women with suspected uncomplicated UTI because microbiology and antibiotic treatment approach tend to be consistent and by the time results are available, most women's symptoms will be resolving or resolved.9 Instead, it recommends women with LUTS should receive empirical antibiotic without urine culture. The most probable reason why this investigation was done is because she was feverish and lethargic that developed from initial presentation of dysuria. Despite other observations were normal, this could escalate to an upper urinary tract infection if not treated properly.6 Furthermore, her previous UTI episode was treated with trimethoprim and may potentially lead to an increased risk of trimethoprim resistance.12 Therefore, ordering urine culture and microscopy in this case is a reasonable investigation not only to ascertain the diagnosis but also to ensure sensitivity of
Background
UTI is one of the most common problems for which young women seek medical attention, accounting for nearly 25% of all infections.2 It is estimated that around one-third of women have had …show more content…
Her observations were normal apart from fever. Although it is fairly certain this is an uncomplicated UTI based on history and examination, one study showed that the diagnostic accuracy for UTI by relying just on clinical assessment remains unclear.8 According to the SIGN and NICE guidelines, the first line of investigation for UTI is urinalysis as this enhances diagnostic accuracy and thus, reduces the chance of prescribing unnecessary antibiotics.9-11 Further investigation was done on her by obtaining a urine sample for culture and microscopy. However, it does raise the question if these are needed to be routinely performed for all patients with UTI. Her previous episode of UTI was 8 months ago and she was treated with trimethoprim. SIGN guidelines do not routinely recommend urine microscopy and culture for women with suspected uncomplicated UTI because microbiology and antibiotic treatment approach tend to be consistent and by the time results are available, most women's symptoms will be resolving or resolved.9 Instead, it recommends women with LUTS should receive empirical antibiotic without urine culture. The most probable reason why this investigation was done is because she was feverish and lethargic that developed from initial presentation of dysuria. Despite other observations were normal, this could escalate to an upper urinary tract infection if not treated properly.6 Furthermore, her previous UTI episode was treated with trimethoprim and may potentially lead to an increased risk of trimethoprim resistance.12 Therefore, ordering urine culture and microscopy in this case is a reasonable investigation not only to ascertain the diagnosis but also to ensure sensitivity of