Ann Arbor Guide to Triaging Adults With Suspected Urinary Tract Infection for In-Person and Telehealth Settings

Area of Science:

• Ambulatory care
• Infectious disease management
• Clinical decision support

Background:

• Urinary tract infections (UTIs) are a leading cause for antibiotic prescriptions in ambulatory care.
• Existing guidelines offer limited outpatient advice on UTI patient triage.
• Standardized triage is needed to optimize antibiotic use and patient outcomes.

Purpose of the Study:

• To evaluate the appropriateness of various triage and management strategies for suspected UTIs in outpatient settings.
• To assess recommendations for empiric antibiotics, urine testing, and visit types.
• To determine how these recommendations differ based on patient demographics and symptoms.

Main Methods:

• Utilized the RAND/UCLA Appropriateness Method with a multidisciplinary expert panel.
• Conducted a scoping literature review from 2009 to June 2024.
• Rated the appropriateness of 1094 clinical scenarios involving UTI management strategies for adult men and women.

Main Results:

• Recommended same-day in-person evaluation for symptoms suggesting pyelonephritis, complicated cystitis, or obstruction.
• Suggested a visit for non-urinary symptoms like diarrhea or cough.
• Advised empiric treatment without testing for women with classic cystitis symptoms and low resistance risk.
• Recommended urinalysis with culture before antibiotics for men and women at risk of resistance.
• Supported empiric treatment for patients facing barriers to timely testing or visits.

Conclusions:

• Defined appropriate criteria for triaging adults with suspected UTIs in ambulatory and telehealth settings.
• Aimed to standardize and enhance the appropriateness of antibiotic prescribing, urine testing, and visit type selection.
• These criteria are expected to improve the management of common UTIs in outpatient care.