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Urinary Tract Infection ELO (UTI diagnosis (Signs/Symptoms (Lower tract…
Urinary Tract Infection ELO
UTI Definition
Epidemiology: common
women (60%)
non-elderly men rarely have UTIs without urinary tract abnormalities
women > men because of shorter urethra and closeness to GI flora
Cystitis: lower infection of the urethra and bladder
Pyelnephritis: upper kidney infection
UTI criteria
Pyelonephritis
Uncomplicated Pyelonephritis
Patient Profile: Otherwise healthy female 18-65 yo. Lesss common than cystitis but same microbiological spectrum
Microbiology
GNR: E. coli (#1), klebsiella, proteus
GPC: staph saprophyticus (honeymoon)
Treatment:
Outpatient
:
Levofloxacin 5d (quinolone)
Cipro 7d (quinolone)
TMP-SMX 10-14d
FQ for severe and good functions
If able to tolerate and no risk for complications, then consider oral antibiotics and keep hydrated
Hospitalized
: IV cetriaxone or aminoglycosides if they have a severe penicillin allergy
Complicated Pyelonephritis
Patient profile
: UTI in complicated patient
Treatment and diagnosis:
Generally treated initially in the hospital with broad spectrum IV antibiotics then switched to more narrow therapy based on cultures
Reviewing antibiotic therapy and watching urine cultures
Imaging of the urinary system with ultrasound, CT
Microbiology
: Pseudomonas, drug resistant gram negatives
Asymptomatic bacteriuria:
lab evidence of bacteria in urine without clinical evidence of infection
DON'T treat unless pregnant or within 1 month post renal transplant
Treatment for pregnant Asx bacteria:
beta lactams safe
fosfomycin safe
-nitrofurantoin (avoid at 1st and term)
-TMP-SM (avoid at 1st and term)
Screen at 12-16 and treat, increased risk of Pyle, pre-term, low birth weight
Cystitis:
Uncomplicated cystitis
Microbiology
GNR: E. coli (#1), klebsiella, proteus (PEK)
GPC: staph saprophyticus (honeymoon)
Treatment
First line:
nitrofuratoin (normal kidney)
fosfomycin
trimethoprim(TMP-SXP)
Some kind of DNA inhibiting 1st antibiotic
Fluroquinolones not used first can cause C. diff
Patient Profile:
otherwise healthy female 18-65
no other anatomic abnormalities or predisposing conditions
Risk: sexual activities, prior history, antibiotics, spermicides
Complicated Cystitis
Microbiology:
E. coli still most common, more resistant
Pseudomonas is also a larger concern
GPC: group B, enterococcus more common
Treatment: Often initially IV therapy such as
cefepime plus or minus a gram positive agent
Patient Profile:
UTI in everyone else
risk of drug resistance
structural/neurologic abnormality
UTI pathophysiology
Urethra becomes colonized by GI bacteria and pathogen ascends to the bladder causing the lower tract infection. Some continue to ascend and cause the upper tract infection
UTI diagnosis
Testing
Urinalysis: midstream catch and if there are squamous epithelial cells it is indicative of a contaminated specimens
UA findings:
leukocyte esterase
nitrates
Pyuria > 10 WBC
WBC casts
All can also be seen in the absence of infection
NO UA findings in isolation can diagnosis a UTI
Bacteria seen on microscopy does NOT prove infection
Culture
Obtain in any complicated UTI prior to antibiotics
Classically colony counts have been part of diagnosis to
try to determine colonization vs contaminant
Bacterial growth at any concentration without symptoms does not diagnose UTI
Signs/Symptoms
Lower tract:signs of irritation
Upper tract:N/V, flank pain, systemic infectious symptoms
Neurology:spasticity
Confusion without sepsis is NOT a localizing sign in the elderly