Patien are assigned one point provide a urine specimen for a culture before any treatment is initiated, since the likelihood of spouitive result is nelatively low(between 26% and Only patients with a positive urine culture for a known uropathogen should receive treatment. For patients with two or more points, empiric therapy targeting Escherichia coli(E. coli) should be prescribed without waiting for the results of a urine culture, because of the high likelihood of infection (> 70% likelihood of a positive urine culture). The use of such a clinical decision aid should help reduce the overuse of antibiotics and thus alleviate some of the selection pressure for antimicrobial resistance in the community
Complicated UTIs
The extent of work up and investigations required for petients with uncomplicated pyelonephritis and UTIs depends on which underlying factors associated with complicated urinary tract infections (listed in table 1)are suspected or known to exist at the timeof clinical presentation. All patients with a suspected uncomplicated pyelonephritis or complicated UTI should provide a urine specimen for culture and antibiotic susceptibility testing, As discussed later, the predictability of the likely pathogen(s) is less dear