Uti

Urinary Tract Infection
Urinary Tract Infection

Upper
urinary tract Infections:
Pyelonephritis
Lower
urinary tract infections
Cystitis
(traditional UTI)
Urethritis (often sexually-transmitted)
Prostatitis
Symptoms of Urinary Tract Infection

Dysuria
Increased
frequency
Hematuria
Fever
Nausea/Vomiting
(pyelonephritis)
Flank pain (pyelonephritis)
Findings on Exam in UTI

Physical
Exam:
Renal angle tenderness (pyelonephritis)

Urethral discharge (urethritis)
Tender prostate on DRE (prostatitis)
Labs:
Urinalysis
+ leukocyte esterase
+ nitrites
More likely gram-negative rods
+ WBCs
+ RBCs
Culture in UTI
Positive
Urine Culture = >105 CFU/mL

Most common pathogen for cystitis,
prostatitis, pyelonephritis:
Escherichia coli
Staphylococcus saprophyticus
Proteus mirabilis
Klebsiella
Enterococcus
Most
common pathogen for urethritis
Chlamydia trachomatis
Neisseria Gonorrhea
Lower Urinary Tract Infection Cystitis

Uncomplicated
(Simple) cystitis
In
healthy woman, with no signs of systemic

disease
Complicated
cystitis
In
men, or woman with comorbid medical

problems.
Recurrent
cystitis
Uncomplicated (simple) Cystitis
Definition
Diagnosis
Dipstick urinalysis (no culture or lab tests needed)
Treatment
Healthy adult woman (over age 12)

Non-pregnant
No fever, nausea, vomiting, flank pain
Trimethroprim/Sulfamethoxazole for 3 days

May use fluoroquinolone (ciprofoxacin or levofloxacin) in
patient with sulfa allergy, areas with high rates of bactrimresistance
Risk factors:
Sexual intercourse
May recommend post-coital voiding or prophylactic antibiotic use.
Complicated Cystitis
Definition
Diagnosis
Females with comorbid medical conditions

All male patients
Indwelling foley catheters
Urosepsis/hospitalization
Urinalysis, Urine culture
Further labs, if appropriate.
Treatment
Fluoroquinolone (or other broad spectrum antibiotic)

7-14 days of treatment (depending on severity)
May treat even longer (2-4 weeks) in males with UTI
Special cases of Complicated

cystitis
Indwelling foley catheter
Try to get rid of foley if possible!

Only treat patient when symptomatic (fever, dysuria)
Leukocytes on urinalysis
Patients with indwelling catheters are frequently colonized with
great deal of bacteria.
Should change foley before obtaining culture, if possible
Candiduria
Frequently occurs in patients with indwelling foley.

If grows in urine, try to get rid of foley!
Treat only if symptomatic.
If need to treat, give fluconazole (amphotericin if resistance)
Recurrent Cystitis
Want
to make sure urine culture and

sensitivity obtained.
May consider urologic work-up to
evaluate for anatomical abnormality.
Treat for 7-14 days.
Pyelonephritis
Infection of the kidney

Associated with constitutional symptoms fever, nausea,
vomiting, headache
Diagnosis:
Treatment:
Urinalysis, urine culture, CBC, Chemistry

2-weeks of Trimethroprim/sulfamethoxazole or fluoroquinolone
Hospitalization and IV antibiotics if patient unable to take po.
Complications:
Perinephric/Renal abscess:
Suspect in patient who is not improving on antibiotic therapy.

Diagnosis: CT with contrast, renal ultrasound
May need surgical drainage.
Nephrolithiasis with UTI
Suspect in patient with severe flank pain

Need urology consult for treatment of kidney stone
Prostatitis
Symptoms:
Diagnosis:
Typical clinical history (fevers, chills, dysuria, malaise, myalgias,

pelvic/perineal pain, cloudy urine)
The finding of an edematous and tender prostate on physical examination
Will have an increased PSA
Urinalysis, urine culture
Treatment:
Pain in the perineum, lower abdomen, testicles, penis, and with ejaculation,
bladder irritation, bladder outlet obstruction, and sometimes blood in the
semen
Trimethoprim/sulfamethoxazole, fluroquinolone or other broad spectrum

antibiotic
4-6 weeks of treatment
Risk Factors:
Trauma
Sexual abstinence
Dehydration
Question #1
An
18-year old woman presents with

urinary frequency, dysuria, and lowgrade fever. Urinalysis shows pyuria
and bacilli. She has never had similar
symptoms or treatment for urinary tract
infection.
Question # 1
What
category of UTI does this patient

have?
Does this patient require further testing?
Would you treat this patient, and if so,
with what and how long?
Question # 2
An
18-year old woman present with her

third episode of urinary frequency,
dysuria, and pyuria in the past 4 months.
Question # 2
What
further questions do you have for

this patient?
What type of UTI does this patient have?
What testing might you perform in this
patient?
How would you treat her, and for how
long?
Question #3
A 24-year
old woman presents with

fever, chills, nausea, vomiting, flank pain
and tenderness. Her temperature is
40C, pulse rate is 120/min., and blood
pressure is 100/60 mm Hg.
Question # 3
What
further studies do you want in this

patient?
How would you treat this patient?
What might you do if she does not
improve after 3-4 days?
Question # 4
A 78-year
old female presents with an

indwelling foley catheter and pyuria.
Question # 4
What
would you do for this patient at this
time?
How might your work-up/management
change if she was having fevers and
confusion?
Question # 5
58-year
old man presents with his first

episode of urinary frequency and
dysuria. Urinalysis shows pyuria and
bacilli.
Question # 5
What
type of UTI does this patient likely

have?
How would you treat this man, and for
how long?
Question # 6
A 28-year
old male had a sexual

encounter with a prostitute while on a
business trip in Seattle 1 week ago.
After returning home, he noted a burning
sensation on urination and a yellow
discharge in his underwear. Microscopic
examination of the discharge reveals 4+
leukocyte esterase, and the following
gram stain.

Uti

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Urinary Tract Infection

Urinary Tract Infection

urinary tract Infections:

urinary tract infections

Symptoms of Urinary Tract Infection

Findings on Exam in UTI

Renal angle tenderness (pyelonephritis)

More likely gram-negative rods

Urine Culture = >105 CFU/mL

common pathogen for urethritis

Lower Urinary Tract Infection Cystitis

healthy woman, with no signs of systemic

men, or woman with comorbid medical

Uncomplicated (simple) Cystitis

Dipstick urinalysis (no culture or lab tests needed)

Healthy adult woman (over age 12)

Trimethroprim/Sulfamethoxazole for 3 days

May recommend post-coital voiding or prophylactic antibiotic use.

Females with comorbid medical conditions

Fluoroquinolone (or other broad spectrum antibiotic)

Special cases of Complicated

Indwelling foley catheter

Try to get rid of foley if possible!

Should change foley before obtaining culture, if possible

Frequently occurs in patients with indwelling foley.

to make sure urine culture and

Infection of the kidney

Urinalysis, urine culture, CBC, Chemistry

Suspect in patient who is not improving on antibiotic therapy.

Nephrolithiasis with UTI

Suspect in patient with severe flank pain

Typical clinical history (fevers, chills, dysuria, malaise, myalgias,

Trimethoprim/sulfamethoxazole, fluroquinolone or other broad spectrum

18-year old woman presents with

category of UTI does this patient

18-year old woman present with her

further questions do you have for

old woman presents with

further studies do you want in this

old female presents with an

would you do for this patient at this

old man presents with his first

type of UTI does this patient likely

old male had a sexual

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