Don’t do a urine dip or send urine specimens for culture when patients/clients/residents (including the elderly or persons with diabetes) do not have urinary tract symptoms or when following up to confirm effective treatment. Testing should only be done when there are urinary tract infection (UTI) symptoms such as urinary discomfort, frequency, urgency, supra-pubic pain, flank pain or fever. Dark, cloudy and/or foul-smelling urine may not be suggestive of UTI but rather of inadequate fluid intake. Delirium by itself is not considered a symptom of cystitis in non-catheterized patients. Testing often shows bacteria in the urine, with as many as 50% of those tested showing bacteria without localizing symptoms to the genitourinary tract. Over-testing and treating asymptomatic bacteriuria with antibiotics lead to an increased risk of diarrhea and infection with Clostridium difficile. Overuse of antibiotics contributes to increasing antimicrobial resistance. The only exceptions to such overuse are screening in early pregnancy, for which there are clear guidelines, and screening for asymptomatic bacteriuria before urologic procedures in which mucosal bleeding is anticipated.
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