Table 2.

Comparison of Definitions of Symptomatic Urinary Tract Infection

(NIDRR) – 19925	(IDSA) – 20096
■ Bacteriuria (≥100 bacteria/mL of urine) with tissue invasion and resultant tissue response with signs and/or symptoms.	■ CA-UTI in patients with indwelling urethral, indwelling suprapubic, or intermittent catheterization is defined by the presence of symptoms or signs compatible with UTI with no other identified source of infection along with ≥1000 cfu/mL of ≥1 bacterial species in a single catheter urine specimen or in a midstream voided urine specimen from a patient whose urethral, suprapubic, or condom catheter has been removed within the previous 48 h.
■ Signs and symptoms: Leukocytes in the urine generated by the mucosal lining; discomfort or pain over the kidney or bladder, or during urination; onset of urinary incontinence; fever; increased spasticity; autonomic hyperreflexia; cloudy urine with increased odor; malaise, lethargy, or sense of unease.	■ Data are insufficient to recommend a specific quantitative count for defining CA-UTI in symptomatic men when specimens are collected by condom catheter.
	■ CA-ASB should not be screened for except in research studies evaluating interventions designed to reduce CA-ASB or CA-UTI and in selected clinical situations, such as in pregnant women.
	■ CA-ASB in patients with indwelling urethral, indwelling suprapubic, or intermittent catheterization is defined by the presence of ≥100,000 cfu/mL of ≥1 bacterial species in a single catheter urine specimen in a patient without symptoms compatible with UTI.
	■ CA-ASB in a man with a condom catheter is defined by the presence of ≥100,000 cfu/mL of ≥1 bacterial species in a single urine specimen from a freshly applied condom catheter in a patient without symptoms compatible with UTI.
	■ Signs and symptoms compatible with CA-UTI include new onset or worsening fever, rigors, altered mental status, malaise, or lethargy with no other identified cause; flank pain; costovertebral angle tenderness; acute hematuria; pelvic discomfort; and in those whose catheters have been removed, dysuria, urgent or frequent urination, or suprapubic pain or tenderness.
	■ In patients with spinal cord injury, increased spasticity, autonomic dysreflexia, or sense of unease are also compatible with CA-UTI.
	■ In the catheterized patient, pyuria is not diagnostic of CA-bacteriuria or CA-UTI. The presence or absence of odorous or cloudy urine alone should not be used to differentiate CA-ASB from CA-UTI or as an indication for urine culture or antimicrobial therapy.
	■ The presence, absence, or degree of pyuria should not be used to differentiate CA-ASB from CA-UTI.
	■ Pyuria accompanying CA-ASB should not be interpreted as an indication for antimicrobial treatment.
	■ The absence of pyuria in a symptomatic patient suggests a diagnosis other than CA-UTI.

CA-ASB, catheter-associated asymptomatic bacteriuria; CA-UTI, catheter-associated urinary tract infection; cfu/mL, colony-forming units per milliliter; IDSA, Infectious Diseases Society of America; NIDRR, National Institute on Disability and Rehabilitation Research; UTI, urinary tract infection.