Urinary tract infection: Difference between revisions

From IDWiki
No edit summary
No edit summary
Line 1: Line 1:
== Background ==
==Background==


*Bacterial infection of the urinary tract, either lower (cystitis) or upper (pyelonephritis)
*Bacterial infection of the urinary tract, either lower (cystitis) or upper (pyelonephritis)
*When UTI causes sepsis syndrome, often referred to as urosepsis
*When UTI causes sepsis syndrome, often referred to as urosepsis


=== Microbiology ===
===Microbiology===


*Gram-negative bacteria
*Ascending genitourinary infection
**''[[E. coli]]''
**[[Escherichia coli]], most common cause overall
**[[Proteus]], [[Klebsiella]], [[Enterobacter]]
**''[[S. saprophicitus]]''
**[[Pseudomonas]], [[Acinetobacter]]
* Gram-positive bacteria
**[[Staphylococcus saprophyticus]], more common in young women
**[[Enterococcus faecalis]]
**[[Enterococcus faecalis]]
**[[Staphylococcus aureus]], as a complication of [[Staphylococcus aureus bacteremia]]
*Bacteremia
**[[Staphylococcus aureus]]
**[[Corynebacterium urealyticum]]
*Viruses
**[[Candida species]]
**[[Adenovirus]], which can cause [[hemorrhagic cystitis]] in [[hematopoietic stem cell transplantation]] recipients
**[[BK virus]], in renal transplant recipients

=== Risk Factors ===

* '''Premenopausal women:''' sexual intercourse, new partner, no postcoital voiding, spermicide use, prior UTI, [[diabetes mellitus]]
* '''Postmenopausal women:''' estrogen deficiency, incontinence, postvoid residual, catheterization
* '''Men:''' reduced prostatic secretions (older men), postvoid residual, incontinence, catheterization


==Clinical Manifestations==
==Clinical Manifestations==
Line 29: Line 40:
==Investigations==
==Investigations==


*Urinalysis
*Urinalysis has high NPV (~100%) if negative for leukocyst esterase and nitrites
**Leukocyte esterase
**Nitrite, positive for organisms that convert nitrate to nitrite such as the Gram-negative bacteria
**High negative predictive value if both LE and nitrite are negative
*Urine microscopy
**Pyuria indicated by 5-10 cells per HPF


[[Category:Genitourinary infections]]
[[Category:Genitourinary infections]]

Revision as of 15:45, 24 August 2020

Background

  • Bacterial infection of the urinary tract, either lower (cystitis) or upper (pyelonephritis)
  • When UTI causes sepsis syndrome, often referred to as urosepsis

Microbiology

Risk Factors

  • Premenopausal women: sexual intercourse, new partner, no postcoital voiding, spermicide use, prior UTI, diabetes mellitus
  • Postmenopausal women: estrogen deficiency, incontinence, postvoid residual, catheterization
  • Men: reduced prostatic secretions (older men), postvoid residual, incontinence, catheterization

Clinical Manifestations

  • Diagnostic criteria include clinical and laboratory symptoms:
    • Two or more clinical symptoms:
      • Fever > 38ºC
      • Urinary urgency or frequency
      • Acute dysuria
      • Hypogastric pain
      • Costovertebral angle tenderness
    • One or more laboratory finding:
      • Bacteriuria (> 100,000 CFUs/mL)
      • Pyuria (>10 WBCs/HPF)

Investigations

  • Urinalysis
    • Leukocyte esterase
    • Nitrite, positive for organisms that convert nitrate to nitrite such as the Gram-negative bacteria
    • High negative predictive value if both LE and nitrite are negative
  • Urine microscopy
    • Pyuria indicated by 5-10 cells per HPF