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Pathogenic microorganisms are detected Growth of > 105 organism/mm midstream clean catch 102-104/ml by suprapubic aspiration, indwelling catheter or in-out catheterization
Persistence of original infecting strain New strain Unresolved renal or prostatic infection Persistent vaginal or intestinal infection leading to reinfection of the bladder
Dysuria, frequency and urgency Unaccompanied by significant bacteriuria Actual bladder infections
Females
1-3% of school girls Increasing at the onset of sexual activity More common among younger women
Males
<1year of age or for those with genital abnormality >50 years old
Elderly
Asymptomatic bacteriuria 40-50%
* found in women with urethral syndrome and low colony counts Associated with recurrent infections and urologic manipulations Found in patients with renal stones and urologic surgery/instrumentation
Adenovirus
Acute hemorrhagic cystitis in children
Risk factors
Anatomic considerations Intercourse / sexual habits uncircumcised Use of contraceptives (spemicides) Bladder invasion by E. coli
O, K, H serogroups, fimbriae and cytotoxins Catheter associated UTI
HIV Pregnancy Obstructions (tumors, strictures, stones or prostate) Neurologic bladder dysfunction Vesicoureteral reflux
S/Sx
Dysuria, frequency, urgency and suprapubic pain Fever nausea and vomiting Malodorous, cloudy urine Bloody urine in 30% Urethral or suprapubic tenderness, CVA tenderness Check for vaginal discharges
No mitigating circumstances
Oral TMP-SMX, TMX, quinolone 3 days Nitrofurantoin 7 days
DM, >7 days of symptoms, recent UTI, use of diaphragm, >65 y/o, pregnant
Oral TMP-SMX, quinolone 7 days
S/Sx
Rapid development of fever, chills, nausea, vomiting, abdominal pain, diarrhea Cystitis (+) CVA tenderness and on deep abdominal palpation Pyuria, bacteriuria, pus casts, Hematuria*
*if persistent rule out TB, stone or tumor
S/Sx
Acute dysuria, frequency and pyuria 30% with no growth or insignificant growth
r/o E. coli vs STDs
If chronic, check:
New sexual partner with hx of transmitted dse Mucopurulent cervicitis
Chlamydial infxn
Azithromycin 1g single oral dose Doxycycline 100mg bid x 7 days
S/Sx
Minimal symptoms Gram (-) bacteremia Can be prevented through proper aseptic techniques Usually successful for those catheterized for <2 weeks
Arising from catheterization, manipulation, immunosuppression, anatomic, functional, urologic, stone obstructions, renal disease or diabetes With mild to moderate illness, no nausea or vomiting OPD Severe illness possible urosepsis requiring hospitalization
Ciprofloxacin or levofloxacin for 10-14 days
IV ampicillin and gentamicin, ceftriaxone, aztreonam, ticarcillin/clavulanate, or imipenem cilastatin then oral quinolone or TMP-SMX for 10-21 days
Asymptomatic Bacteriuria
Antibiotic oftentimes unnecessary unless with symptoms
Pregnancy
Amoxicillin, nitofurantoin, or cephalosporin Low dose prophylaxis with nitrofurantoin for those with recurrent infection
Bacterial count
Symptomatic patients: >105/ml Asymptomatic patients: >105/ml in 2 consecutive specimen with presence of a single species in both Suprapubic aspiration or catheterizatiopn: >102/ml
Microscopy
Gram stain Pyuria Leukocyte esterase dipstick test
Cultures
Women
Usually not recommended Relapsing infections Childhood infections Stones Painless hematuria Recurrent pyelopnephritis
Males
Recommended Except: AIDS, uncircumcised, recent sexual activity
Diabetes, sickle cell disease, chronic alcohololism, and vascular disease Hematuria, flank or abdominal pain Chills and fever Acute renal failure, oliguria and anuria Presence of ring shadow on pyelography
Tx
High fever, leukocytosis, renal parenchymal necrosis and presence of fermentative gases in kidneys and perinephric tissues seen in plain film/CT E. coli and enterobactericeae Surgical resection/systemic antibiotics needed
E. coli and gm (-) rods Related to bladder outlet obstruction/DM Abdominal pain, dysuria, frequency and pneumaturia. Gas with the bladder lumen and bladder wall by CT Systemic antibiotics Relief of obstruction Cystectomy
Spontaneously in young men and those with indwelling urethral catheter in older men Fever, chills, dysuria and tender, boggy prostate
E. coli or Klebsiella (for non catheter related infxn)
IV flouroquinolones 3rd gen cephalosporin or an aminoglycoside
Gram (-) rods for catheter related infxn Imipenem, aminoglycoside, flouroquinolones or a 3rd gen cephalosporin Sequelae:
Abscess formation, epidymoorchitis, seminal vesiculitis, septicemia or residual chronic bacterial prostatitis
Infrequent, relapsing infection in a middle age man Asymptomatic, with normal prostate on palpation. May produce symptoms of cystitis Presence of E. coli, Klebsiella, proteus in prostatic secretions or post massage urine TX Floroquinolones for 12 weeks Low dose antimicrobial (sulfonamide, TMP, nitrofurantoin) Total prostatectomy/transurethral prostatectomy