25
d
Appendix D: IOU Consensus Criteria
Algorithm for the Diagnostic Approach to Acute Simple
(Uncomplicated) Cystitis in Non-Catheterized Nursing Home Residents
Is This A Simple Uncomplicated Bladder Infection?
(Cystitis)
Evaluate &
treat as possible
complicated UTI.
Cystitis likely. Obtain
urine and treat
empirically.
Cystitis likely. Obtain
urine and treat
empirically.
Unlikely cystitis.
Active monitoring
& evaluate for other
cause
Resident
has dysuria
AND one other
symptom in Box
2.
Resident has
hematuria AND
suprapubic pain?
Box 1 – Warning
Signs & Symptoms of
Complicated UTI
• Fever
• Flank pain
• Rigors/chills
• Prostatic/scrotal pain
• Urinary catheter
• Hypotension
• Elevated serum WBC
Box 2 – Simple Cystitis
Symptoms
• Gross hematuria
• Suprapubic pain
• Urinary frequency/
urgency
YES NO
YES
NO
YES NO
Resident has urinary
catheter
OR
Has ≥2 warning signs or symptoms
suggesting possible complicated urinary
tract infection such as pyelonephritis,
renal abscess, prostatitis?
(See Box 1)
Source: Nace DA, Perera SK,
Hanlon JT, et al. e Improving
Outcomes of UTI Management
in Long-Term Care Project
(IOU) consensus guidelines for
the diagnosis of uncomplicated
cystitis in nursing home
residents. J Am Med Dir Assoc
2018;19:765e769.e3.
