urinary tract infection

URINARY TRACT
INFECTION
- Akshay Singh

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:
 CVA 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…..
 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
 Healthy adult woman (over age 12)
 Non-pregnant
 No fever, nausea, vomiting, flank pain
 Diagnosis
 Dipstick urinalysis (no culture or lab tests needed)
 Treatment
 Trimethroprim/Sulfamethoxazole for 3 days
 May use fluoroquinolone (ciprofoxacin or levofloxacin) in
patient with sulfa allergy, areas with high rates of bactrim-
resistance
 Risk factors
 Sexual intercourse
 May recommend post-coital voiding or prophylactic antibiotic use.

Complicated Cystitis
 Definition
 Females with comorbid medical conditions
 All male patients
 Indwelling foley catheters
 Urosepsis/hospitalization
 Diagnosis
 Urinalysis, Urine culture
 Further labs, if appropriate.
 Treatment
 Fluoro-quinolone (or other broad spectrum antibiotic)
 7-14 days of treatment (depending on severity)
 May treat even longer (2-4 weeks) in males with UTI

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:
 Urinalysis, urine culture, CBC, Chemistry
 Treatment:
 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:
 Pain in the perineum, lower abdomen, testicles, penis, and
with ejaculation, bladder irritation, bladder outlet obstruction,
and sometimes blood in the semen
 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:
 Trimethoprim/sulfamethoxazole, fluroquinolone or other broad
spectrum antibiotic
 4-6 weeks of treatment
 Risk Factors:
 Trauma
 Sexual abstinence
 Dehydration

Urethritis
 Chlamydia trachomatis
 Frequently asymptomatic in females, but can present with dysuria,
discharge or pelvic inflammatory disease.
 Send UA, Urine culture (if pyuria seen, but no bacteria, suspect
Chlamydia)
 Pelvic exam – send discharge from cervical or urethral os for
chlamydia PCR
 Chlamydia screening is now recommended for all females ≤ 25
years
 Treatment:
 Azithromycin – 1 g po x 1
 Doxycycline – 100 mg po BID x 7 days
 Neisseria gonorrhoeae
 May present with dysuria, discharge, PID
 Send UA, urine culture
 Pelvic exam – send discharge samples for gram stain, culture,
PCR
 Treatment:
 Ceftriaxone – 125 mg IM x 1
 Cipro – 500 mg po x 1

Final thoughts!
 Antibiotic choice and duration are determined
by classification of UTI.
 Biggest bugs for UTI are E. Coli, Staph.
Saprophyticus, Proteus mirabilis, Enterococci
and gram-negatives
 Don’t use moxifloxacin for UTI!
 Chlamydia screening is now recommended for
all women 25 years and under since infection
is frequently asymptomatic, and risk for
PID/infertility is high!

urinary tract infection

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urinary tract infection