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Revised McGeer Criteria for Urinary Tract Infection Surveillance (UTIs)

The definitions for UTI presented here differ substantially from the original surveillance definitions1 for both (A) residents without an indwelling catheter and (B) residents with an indwelling catheter. The revised definitions take into account the low probability of UTI in residents without indwelling catheters if localizing symptoms are not present, as well as the need for microbiologic confirmation for diagnosis.

Revised McGeer Criteria for Urinary Tract Infection Surveillance (UTIs)

Urinary tract infection includes only symptomatic urinary tract infections. Surveillance for asymptomatic bacteriuria (defined as the presence of a positive urine culture in the absence of new signs and symptoms or urinary tract infection) is not recommended, as this represents baseline status for many residents.

Symptomatic urinary tract infection
One of the following criteria must be met:

A- The resident does not have an indwelling urinary catheter and has at least three of the following signs and symptoms:

  • Fever (>38ºC) or chills
  • New or increased burning pain on urination, frequency or urgency
  • May be new or increased incontinence
  • New flank or suprapubic pain or tenderness
  • Change in character of urine [may be clinical (e.g., bloody urine) or as reported by the laboratory (new pyuria or microscopic hematuria). For laboratory changes a previous urinalysis must have been negative].
  • Worsening of mental or functional status

B- The resident has an indwelling catheter and has at least two of the following signs or symptoms:

  • Fever (>38º C) or chills
  • New flank or suprapubic pain or tenderness
  • Change in character of urine [may be clinical (e.g., bloody urine) or as reported by the laboratory (new pyuria or microscopic hematuria). For laboratory changes a previous urinalysis must have been negative]
  • Worsening of mental or functional status

 

References:

  1. Stone ND, Ashraf MS, Calder J, Crnich CJ, Crossley K, Drinka PJ, Gould CV, Juthani-Mehta M, Lautenbach E, Loeb M, Maccannell T, Malani PN, Mody L, Mylotte JM, Nicolle LE, Roghmann MC, Schweon SJ, Simor AE, Smith PW, Stevenson KB, Bradley SF; Society for Healthcare Epidemiology Long-Term Care Special Interest Group. Surveillance definitions of infections in long-term care facilities: revisiting the McGeer criteria. Infect Control Hosp Epidemiol. 2012 Oct;33(10):965-77. [Medline]
  2. Ryan S, Gillespie E, Stuart RL. Urinary tract infection surveillance in residential aged care. Am J Infect Control. 2018 Jan;46(1):67-72. [Medline]

Created May 11, 2021.

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