Urinary Tract Infection

Definition
symptoms suggestive UTI + evidence of pyuria and bacteriuria
on Urinalysis asymptomatic bacteriuria; only requires treatment
in certain patients (e.g. pregnancy)
Classification
uncomplicated: lower UTI in a setting of functionally and
structurally normal urinary tract
complicated: structural and/or functional abnormality,
immunocompromised, iatrogenic complication, pregnancy,
pyelonephritis, catheter-associated
recurrent: Recurrent/Chronic Cystitis
Risk Factors
stasis and obstruction:
o residual urine due to impaired urine flow e.g. PUVs,
reflux, medication, BPH, urethral stricture, cystocele,
neurogenic bladder
foreign body:
o introduce pathogen or act as nidus of infection e.g.
catheter, instrumentation
decreased resistance to organisms:
o DM, malignancy, immunosuppression, spermicide use,
estrogen depletion, antimicrobial use
other factors:
o trauma, anatomic abnormalities, female, sexual
activity, fecal incontinence
Clinical Features
storage symptoms: frequency, urgency, dysuria
voiding symptoms: hesitancy, post-void dribbling
other: suprapubic pain, hematuria, foul-smelling urine
pyelonephritis if present: typically presents with more
severe symptoms (e.g. fever/chills, CVA tenderness, flank
pain)
Part of Urinary Tract Affected
Sign & Symptoms
Kidney ( Acute Pyelonephritis)
- Flank Pain
- High Fever with shaking chills
- Nausea & Vomiting
- Fatigue & Weakness
Bladder (Cystitis)
- Pressure or cramping in lower
abdomen
- Low Fever
- Pain or burning Urination
(Dysuria)

Urethra (Urethritis)

Cloudy or Bloody urine, with

foul odor
Frequency
Dysuria

Treatment
9
9 Uncomplicated UTI: Treat on an outpatient basis with PO TMPSMX or a fluoroquinolone 3 days, or nitrofurantoin 7
days(for pregnant woman).
Diseases
Drug of Choice
Cystitis
Acute
TMP/SMX (x3d)
Uncomplicat
TMP (x3d)
ed
Nitrofurantoin
Cystitis
(x7d)
(AUC)
Recurrent
TMP/SMX
(<1mt)
TMP
Treat: 10Nitrofurantoin
14d
TMP/SMX
TMP
Complicated
Nitrofurantoin
Treat: 10-14
Gentamycin +/days
Ampicillin (IV)
Tobramycin +
Ampicillin (IV)
Pyelonephritis
TMP/SMX
Pyelonephriti
TMP
s
Norfloxacin
(out patient)
Ciprofloxacin
Ampicillin +
Pyelonephriti
Tobramycin (IV)
s
Gentamycin +/(in patient)
Ampicillin (IV)