Urinary tract infection in women (simple cystitis, at risk of complications, recurrent, pyelonephritis)

In the practice

• Urine dipstick (leucocytes and nitrites)
• No urine microscopy and culture: empirical treatment if the dipstick is positive (leucocytes or nitrites).

Only if progress is unfavourable

• Urine microscopy and cultureif neededSigns persisting or worsening after 3 days of treatment, or early recurrence within 2 weeks ^[2].

Urine tests, before any antibiotic

• Urine dipstick (in the practice)
• Urine microscopy and culture with susceptibility testing

Laboratory tests

• Serum creatinine with eGFRif neededRenal function unknown when nitrofurantoin is being considered: it is contraindicated if GFR is < 45 mL/min ^[2].

At the first recurrences

• Urine microscopy and culture with susceptibility testing

Before antibiotic prophylaxis (1 to 2 weeks before the start)

• Urine microscopy and culture (must be sterile before starting)if neededOnly if antibiotic prophylaxis is decided (at least one cystitis a month despite other measures) ^[2,3].

Urine tests, before the start of the antibiotic

• Urine dipstick (in the practice)
• Urine microscopy and culture with susceptibility testing, whatever the dipstick result
• Renal ultrasound within 24 hours if the pyelonephritis is hyperalgic.

Urine tests, before the start of the antibiotic

• Urine microscopy and culture with susceptibility testing

Laboratory tests

• CRP
• Serum creatinine with eGFR
• FBCif neededSevere pyelonephritis (sepsis, shock, obstruction to be drained): FBC, CRP, urea and creatinine recommended ^[3], most often in the emergency department.
• Blood culturesif neededRoutine in severe pyelonephritis; otherwise only if the diagnosis is in doubt ^[3].
• CT urography, most often urgently, within 24 hours at the latest (renal ultrasound if contraindicated).
• Sepsis, septic shock or obstruction of the urinary tract: refer to the emergency department.