UTIs
Types
Anatomical:
Complexity
- Lower UTI: cystitis (bladder), urethritis (urethra), prostatitis (prostate) (fever uncommon)
-Upper UTI: pyelonephritis- kidney and ureters (acute and chronic), renal abscess (fever common)
- Uncomplicated (cystitis, in a nonpregnant, non-elderly adult woman w/ normal anatomy
- Complicated: everything else
Entry and Development
Ascending, hematogenous, and lymphatic pathways
Development depends on bacterial virulence, host defenses, and host-organism interactions
Symptoms
Diagnosis
Treatment
Cystitis
Dysuria (burning), frequency,
Clean-catch: assess for
Uncomplicated- 3 days of
urgency; suprapubic tenderness,
pyuria (WBCs in urine)
fluoroquinolone or doxy or amp; trim-sulf
hematuria (50%)
and bacteruria
Complicated- Get urine culture (urologic
work up in males), treat 7-14 days
Urethritis
Often due to STD, in women can be
confused w/ cystitis or vaginitis
(perineal complaints)
Acute
Inflammation of the prostate;
Urinalysis for bacteruria/ Trim-sulfa or quinolones- 14 days
bacterial
abrupt onset of fever, chills, low
pyuria and urine culture
75% of infection- GNR; 25% due to Gm
Prostatitis
back/ perineal pain w/ dysuria, freq,
urgency; avoid rectal exam (can
induce bacteremia)
Chronic
Asymptomatic or have
Urine w/ pyuria,
Difficult to treat: use trim-sulf or
bacterial
back/perineal pain w/ dysuria,
bacteruria, and urine
quinolones 6-12 wks
prostatis
frequency, urgency
culture; UAC&S before/
after prostatic massage,
collect secretion
Pyelonephritis Dysuria, freq, urgency w/ fever,CVA; Pyuria, bacteruria,
E.coli 85%; 14 days of ampicillin + AG;
N/V/D; occasional signs of cystitis
positive urine culture in
also could do fluoroquinolones, ext spect
are absent; elderly may present w/
the proper clinical
pcns, 3rd gen cephs
septic picture (if fever > 72 hours
setting; blood cultures
consider renal abscess); flank
may be +
tender, patient may appear septic
Renal abscess Rare compication of upper UTI
CT or ultrasound
Direct against GNR/ S. aureus: E.coli,
(patients w/ DM, abn. urinary tract,
Enterobac, S. aureus
or w/ hematogenous route of
Ext spectrum pcns, AG + anti-staph pcn or
infection (S. aureus); fever, chills,
cephalosporin; surgical drainage
flank pain (insidious onset)
Catheter UTI
Most common org are E. coli, proteus,
pseudo-monas, enterococci
(polymicrobic); use broad spec antibiotics
for symptomatic infections only, change
catheter, use 14 days if toxic, otherwise
use 3-5 (don’t sterilize the urine
Pregnancy UTI
Screen all preg w/ urine
Amoxicillin, trim-sulfa, nitrofurantoin,
st
th
culture- 1 visit, 28 wk; cephalosporins for 7-10 days; follow up
16th wk if single screen
culture at 1 and 4 wks
Dysuria= burning during or after urination
Pyuria= >10 leukocytes / high power field on a “spun” urine sample, urine dipstick for keulocyte esterase can screen for
Bacteruria= >10^5 bacteria/milliliter is significant bacteruria for GNR from a clean catch or cath
Hematuria= blood in the urine (micro or macro)
UTIs
Dysuria= burning during or after urination
Pyuria= >10 leukocytes / high power field on a “spun” urine sample, urine dipstick for keulocyte esterase can screen for
Bacteruria= >10^5 bacteria/milliliter is significant bacteruria for GNR from a clean catch or cath
Hematuria= blood in the urine (micro or macro)