Researchers and clinicians in Michigan have developed new guidance for triage and management of suspected urinary tract infections (UTI) symptoms in patients seeking care via telehealth and virtual visits.

Although guidelines exist for the management of suspected UTIs in patients who make in-person visits to outpatient clinics and can be physically examined, there is limited guidance for the increasing number of patients who seek care for presumed UTIs through video visits, phone visits, and portal requests. 

“These virtual requests present a unique challenge for clinicians who must decide if the patient’s symptoms are consistent enough with a UTI that antibiotics provide more benefit than risk, without performing a physical examination, and whether urine testing is necessary,” clinicians and researchers from the University of Michigan Medical School and the Veterans Affairs Ann Arbor Healthcare System (VAAAHS) wrote yesterday in JAMA Network Open.

To address this gap, they convened a meeting of national experts to develop appropriateness criteria for urine testing, empiric antibiotic use, and triage for additional evaluations in these patients.

Algorithms guide treatment decisions

The result is two algorithms for uncomplicated UTI management—one for non-pregnant women and one for men—that clinicians can use in any setting to determine whether urine testing, empiric antibiotics, and further examination are needed. The guidance also addresses patients with more complicated health conditions and symptoms that could indicate a more serious health issue.

The authors of the paper say the guidance is needed because UTIs are one of the most common reasons for antibiotic use in outpatient settings, but far fewer patients are being seen in a setting where a urine sample can be collected to confirm an infection.

“We hope that this guide will help both patients and providers be aware that even though they’re now able to take a questionnaire or interact with a provider completely virtually, that alone may not be enough to get the right diagnosis or treatment,” first author Jennifer Meddings, MD, MSc, a clinician and patient safety researcher at VAAAHS and Michigan Medicine, said in a press release.

Enhanced infection-prevention measures introduced in neonatal intensive care units (NICUs) during the COVID-19 pandemic were associated with a substantial decline in viral health care–associated infections (HAIs), but they did not reduce rates of bacterial or fungal infections, according to a large study published this week in JAMA Network Open. 

The researchers, led by a team at the Children’s Hospital of Philadelphia, analyzed data from 48,475 infants admitted to 12 NICUs in the United States and Canada from March 2018 to July 2022. The goal was to compare infection rates before and amid the pandemic, when measures such as universal masking, enhanced hand hygiene, and increased visitor restrictions were introduced. 

Viral HAIs dropped by half in pandemic

Among 41,889 infants evaluated for viral HAIs, rates fell by more than half during the pandemic, from 0.35 to 0.16 infections per 1,000 patient-days. The decline persisted into the second year of the pandemic, even as circulation of respiratory viruses increased.

In contrast, bacterial and fungal HAIs remained the same before and during the pandemic, at  1.70 and 1.78 infections per 1,000 patient-days, respectively.

The findings suggest that infection-prevention strategies like universal masking and enhanced hand hygiene were effective at limiting viral transmission in NICUs during the pandemic but did not curb bacterial or fungal infections. “Preventive interventions beyond those implemented during the pandemic would likely be necessary to further reduce bacterial or fungal HAIs,” conclude the authors. 

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