From the Guidelines
Yes, if your urinalysis (UA) shows blood along with a urinary tract infection (UTI), you should have a repeat UA after completing antibiotic treatment to ensure the blood has cleared. This recommendation is based on the guidance provided by the American College of Physicians, as outlined in the study published in the Annals of Internal Medicine 1. The study suggests that if infection is suspected based on urinalysis or symptoms, a urine culture should be obtained, and if infection is confirmed, the evaluation should be repeated after treatment to document resolution of hematuria.
Key Points to Consider:
- Hematuria is a common finding in UTIs due to inflammation of the urinary tract lining, but it should resolve with proper treatment 1.
- If blood persists in the follow-up UA despite resolution of other UTI symptoms, further evaluation may be needed to rule out other conditions like kidney stones, tumors, or glomerular disease 1.
- The repeat UA helps confirm that the blood was solely due to the infection and not indicative of another underlying condition requiring additional investigation 1.
- It is also important to assess for other potential causes of asymptomatic microhematuria (AMH) and repeat the UA after treatment of these causes, as recommended by the AUA guideline 1.
Recommendations for Practice:
- Routine urinalysis has questionable utility in asymptomatic patients, and screening healthy asymptomatic patients with the primary intent of cancer detection is not currently recommended by any major health organization 1.
- When dipstick urinalysis is done and results are positive for heme, practitioners should proceed to microscopic confirmation of erythrocytes in the urine before initiating referral 1.
- Practitioners should be aware of risk factors for cancer when considering the finding of hematuria because data suggest that timely referral may be neglected, even in high-risk subgroups 1.
From the Research
Urinalysis (UA) and Urinary Tract Infections (UTIs)
- The presence of blood in a UA with a UTI does not necessarily require a repeat UA, as the primary concern is treating the underlying infection.
- Studies have shown that short treatment regimens for uncomplicated UTIs in women are as effective as and cause fewer side-effects than conventional 10-day chemotherapy 2.
- However, factors such as a history of UTI within the previous 6 weeks and the presence of 10^5 bacteria/mL or greater in an initial midstream culture can affect cure rates 3.
Treatment and Resistance
- Trimethoprim-sulfamethoxazole (TMP-SMX) is a commonly used antibiotic for treating UTIs, but resistance rates can vary depending on the institution and patient population 4.
- Risk factors for TMP-SMX resistance include recurrent UTIs, genitourinary abnormalities, and recent use of TMP-SMX 4.
- Patient-specific risk factors, such as prior urinary infection/colonization with TMP-SMX-resistant Enterobacteriaceae and recent use of TMP-SMX, can predict resistance rates 5.
Clinical Considerations
- The decision to repeat a UA should be based on clinical judgment and the patient's symptoms, rather than solely on the presence of blood in the initial UA.
- Antibiotic treatment should be guided by local resistance patterns and patient-specific risk factors to minimize the risk of treatment failure and promote effective management of UTIs 6, 4, 5.