Microscopic UA and UTI question

[lucy8686]

Hello!

so for a patient with UTI symptoms, who provides a microscopic UA. What on the UA indicates a + UTI? Or warrants needing a culture and sensitivity? It seems some Dr. will start antibiotics based on symptoms right away, then get a UA and culture, while others get a UA and then wait for a reflex culture to come back before initiating treatment. I’m just confused on the diagnosis and treatment. I work on an inpatient psych unit and when patients are admitted they are ordered a microscopic UA but then I feel like it’s the nurses responsibility to call the house Dr. if the UA indicated a UTI. I feel like whenever anything is off on the UA and the patient c/o burning, I am calling and half the time they treat and half the time they say there is no infection based on the UA

[Golden_RN, MSN]

I know this does not answer your question, but I would check if your facility has a policy on when antibiotics are warranted, so as to decrease the use of unnecessary antibiotics.  If not, maybe one is needed.

 

[Nunya, BSN]

Different doctors are going to do different things based on their experience.  This would be a good question to ask if there's a NP group here, or the nephrology group.

[AgentBeast, BSN, RN]

Leukocyte Esterase and Nitrites on UA with bacteria on Micro are indicative of UTI.

[Corey Narry, MSN, RN, NP]

Aside from seeing WBC and bacteria, agree that leukocyte esterase indicates UTI but can be present if the specimen is contaminated with lady partsl contact.  Nitrites on a specimen indicate presence of gram negative bacteria (which convert nitrates to nitrites), however, can also be negative with enterococcus and other gram positive bacteria that can also cause a UTI.  Starting antibiotics is a clinical decision a provider must make to treat based on the UA, patient history, and symptoms.