Investigations for acute cystitis in adults

Do not request urinalysis (a ‘dipstick’ test) for patients without symptoms of acute cystitis.

Do not obtain a urine sample for microscopy and culture in asymptomatic patients except for pregnant patients and patients undergoing elective urological procedures, see asymptomatic bacteriuria in nonpregnant adults.

The diagnosis of acute cystitis in nonpregnant females is usually based on symptoms. For nonpregnant females who have a first episode of acute cystitis, empirical antibiotic therapy can be started based on symptoms alone, provided they do not meet the criteria for urine sampling listed belowWagenlehner, 2022.

Obtain a midstream urine sample for microscopy, culture and susceptibility testing before starting antibiotic therapy from symptomatic patientsBonkat, 2024Cardoso, 2012Kwok, 2022Wagenlehner, 2022:

• for whom the diagnosis of cystitis is uncertain
• who are pregnant
• who are male
• who have recurrent UTI (ie 2 or more infections within 6 months, or 3 or more infections within 12 months)
• residing in an aged-care facility
• who have recently taken antibiotics (within 30 days) because of increased risk of resistant pathogens
• who have risk factors for infection with multidrug-resistant gram-negative bacteria.

Also obtain a urine sample for microscopy, culture and susceptibility testing from patients who do not clinically respond to empirical antibiotic therapy within a week.

Do not perform post-treatment urine culture to confirm resolution of infection for asymptomatic people, except for pregnant patients and those with acute bacterial prostatitis.

Patients with persistent haematuria following an episode of cystitis may require further investigations including upper urinary tract imaging and cystoscopy – seek expert urology adviceKwok, 2022.