Urinalysis Interpretation in Urinary Tract Infections (UTIs)

Learn to interpret dipstick urinalysis and other tests to diagnose urinary tract infections (UTIs). How do we detect bacteria and leukocytes in urine? What else is necessary to diagnose a UTI? How reliable are our diagnostic tests, and what can throw them off? Common problems like urine sample contamination and asymptomatic bacteriuria and leukocyturia make a clinician's job difficult. It's no wonder that misinterpretation of urinalysis and misdiagnosis of urinary tract infections are important drivers of antibiotic misuse worldwide. This video will help you diagnose urinary tract infections and avoid the most common pitfalls in urinalysis.

Lecture summary in PDF:

If you want to learn how to recognize life-threatening infections like sepsis and CNS infections as early as possible, I highly recommend you take my free online course!

A Clinical Approach to Serious Infections in Adults: What Every Physician Should Know:

DISCLAIMER: Please, always keep in mind that my videos are intended for educational purposes only. The content of my videos is NOT medical advice. I do not practice medicine over the internet. If you are a patient and have any questions about your health, please talk to your doctor.

CHAPTERS:
00:00 Urine test strips (urine dipsticks)
00:24 Nitrite in urine
02:45 Leukocyte esterase and leukocyturia
04:20 Microscopic examination or urine sediment, hemocytometry
05:16 How to collect a urine sample and avoid contamination
08:13 Signs of sample contamination
09:28 Significant bacteriuria
11:17 Asymptomatic bacteriuria vs. UTI

REFERENCES & RECOMMENDED READING:
1. Advani SD, Polage CR, Fakih MG. Deconstructing the urinalysis: A novel approach to diagnostic and antimicrobial stewardship. Antimicrob Steward Healthc Epidemiol. 2021;1(1):e6.
2. Wilson ML, Gaido L. Laboratory Diagnosis of Urinary Tract Infections in Adult Patients. Clinical Infectious Diseases. 2004 Apr 15;38(8):1150–8.
3. Pallin DJ, Ronan C, Montazeri K, Wai K, Gold A, Parmar S, et al. Urinalysis in acute care of adults: pitfalls in testing and interpreting results. Open Forum Infect Dis. 2014 Mar;1(1):ofu019.
4. Rowe TA, Juthani-Mehta M. Diagnosis and Management of Urinary Tract Infection in Older Adults. Infect Dis Clin North Am. 2014 Mar;28(1):75–89.
5. Lifshitz E, Kramer L. Outpatient urine culture: does collection technique matter? Arch Intern Med. 2000 Sep 11;160(16):2537–40.
6. Johnson JR, Drekonja DM. Bacteriuria/Pyuria of Clinically Undetermined Significance (BPCUS): Common, but Currently Nameless. The American Journal of Medicine. 2017 May 1;130(5):e201–4.
7. McMurdo M. Commentary. Urinary tract infection in old age: over-diagnosed and over-treated. Age and Ageing. 2000 Jul 1;29(4):297–8.

[clinicaltips]

I want to remind everyone that my videos are for educational purposes only. Of course, everyone is welcome to watch, but the information I present is most useful for junior doctors, nurses, and students. As I stated in the description of every video and on my channel homepage, none of this is medical advice for patients. I don't practice medicine over the internet. If you are a patient and have any questions about your health, please get in touch with your doctor.

[sanbetski]

11:53 symptoms + UA findings concerning for UTI. this scenario can be tricky esp for elderly demented, non verbal, unresponsive patients to elicit history. maybe if there have altered mental status + UA findings go ahead with empiric?

[Gama]

Just found out your channel and I love the content! Subscribed!

[a_son_of_light]

Liked, subscribed, shared.. Thank you.

[sanbetski]

I am loving your channel and lectures. how do you differentiate CAUTI from UTI on a new admitted patient? what is practical working definition for CAUTI? I cannot get a straight forward answer

[freshaire]

Hi, thank you so much for your video, it's very details exactly what I needed. Please can you do videos on hcv infection and tb diagnosis /management( ordering medications) thank you

[tarek]

hi, i really like your channel
i was wondering if you could make a video or reply to my comment about if one should treat fever or not both in adults and children (if so what dose of acetaminophen would you give), because it is conflicting info by doctors about it needs to run its course to increase immune system to fight off the infection. So would you give antipyretics?
Also about why some infections doesnt cause fever and why some infections cause fever

thank you, im a medical student very interested in infectious diseases

[wdposdk]

I’ve had 4 different bacteria and 1 fungal uti at different times. What are the odds that two or more bacteria can be present at the same time since I’ve had four bacteria prior?

[dipakrajbanjara]

can urineanalysis detect gonoreeha and clymedia?

[rokhsala]

I was detected kleibsella 14 days antibiotics with nitrofuratoin again disconfort, fucked up my life 😢

[sanbetski]

8:20 what is your threshold of number of epithelial cells to favor contamination? awesome channel keep it up!

[MarieAntoinette_tmc]

My leukocytes keep coming back positive but nitrates keep coming back negative. The leukocytes on my test doesn't look like they are much. This indicate something serious?

[sanbetski]

our hospital will not reflex to urine culture until wbc >10/hpf despite positive nitrite or leukocyte esterase...

[WynDaviesGraham-tsny]

Can Klebsiella Pneumoniae be an UTI, and can it he sexually transmitted.