Differences in Diagnosis of Urinary Tract Infection (UTI) by Age Group
This section summarises UK‑based diagnostic approaches and practical priorities for suspected UTI, emphasising how diagnostic thresholds, investigations and sampling differ between: women aged <65 years, adults ≥65 years, adults with indwelling urinary catheters (catheter‑associated UTI, CAUTI), and children.
Recommendations are based on NICE guidance (NG109, NG113), the NICE quality statements (QS90) and the GOV.UK diagnostic decision tools. Use local antimicrobial policy for final drug choice.
Key audit / must‑know statements
- Women aged under 65 years: diagnose UTI if two or more key urinary symptoms are present (dysuria, new nocturia, cloudy urine without new vaginal discharge). If this threshold is met, dipstick testing is not required and empirical treatment or a back‑up prescription may be offered (NICE NG109; QS90).
- Adults aged ≥65 years: use a lower diagnostic threshold - an isolated new‑onset dysuria OR two or more urinary or non‑specific features (for example, new delirium, fever, new urgency/frequency, incontinence, suprapubic pain, visible haematuria) should prompt consideration of UTI (GOV.UK diagnostic tool).
- Adults with indwelling catheters: do not use urine dipsticks to diagnose UTI; diagnosis is symptom‑driven and, where indicated, based on an appropriate catheter specimen obtained aseptically (NICE NG113; QS90).
- Do not treat asymptomatic bacteriuria routinely, except in recognised exceptions (for example, pregnancy and some urological procedures). Send urine culture...
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