UTI Vs Pyelonephritis

The first useful question is not simply, "Does this client have a UTI?" It is, "Is the infection confined to the bladder, or has it reached the kidney?" Acute uncomplicated cystitis is bladder-limited. When bacteria ascend into the renal pelvis and parenchyma, the infection is acute pyelonephritis. That distinction changes urgency, investigations, antibiotic selection, treatment length, and monitoring. Burning with urination and urinary frequency in an otherwise well, afebrile client suggests a lower-tract process. Fever with chills, flank or costovertebral-angle pain, nausea, or vomiting suggests the upper tract, with or without the typical cystitis symptoms. A client with fever, rigors, vomiting, and new flank tenderness is not presenting with "just another UTI." The kidney is involved, and systemic deterioration or obstruction must be considered. The second question is just as important for Canadian practice: "Is this a symptomatic infection at all?" Bacteria in the urine without symptoms (asymptomatic bacteriuria) is common, is not an infection, and in most clients does not need testing or treatment. Choosing Wisely Canada and the Association of Medical Microbiology and Infectious Disease Canada (AMMI Canada),...