Urinary tract infection: Difference between revisions
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==Background== |
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*Bacterial infection of the urinary tract, either lower (cystitis) or upper (pyelonephritis) |
*Bacterial infection of the urinary tract, either lower (cystitis) or upper (pyelonephritis) |
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*When UTI causes sepsis syndrome, often referred to as urosepsis |
*When UTI causes sepsis syndrome, often referred to as urosepsis |
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===Microbiology=== |
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*Gram-negative bacteria |
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*Ascending genitourinary infection |
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**[[Escherichia coli]], most common cause overall |
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**[[Proteus]], [[Klebsiella]], [[Enterobacter]] |
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**''[[S. saprophicitus]]'' |
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**[[Pseudomonas]], [[Acinetobacter]] |
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* Gram-positive bacteria |
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**[[Staphylococcus saprophyticus]], more common in young women |
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**[[Enterococcus faecalis]] |
**[[Enterococcus faecalis]] |
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**[[Staphylococcus aureus]], as a complication of [[Staphylococcus aureus bacteremia]] |
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*Bacteremia |
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**[[ |
**[[Corynebacterium urealyticum]] |
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*Viruses |
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**[[Candida species]] |
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**[[Adenovirus]], which can cause [[hemorrhagic cystitis]] in [[hematopoietic stem cell transplantation]] recipients |
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**[[BK virus]], in renal transplant recipients |
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=== Risk Factors === |
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* '''Premenopausal women:''' sexual intercourse, new partner, no postcoital voiding, spermicide use, prior UTI, [[diabetes mellitus]] |
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* '''Postmenopausal women:''' estrogen deficiency, incontinence, postvoid residual, catheterization |
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* '''Men:''' reduced prostatic secretions (older men), postvoid residual, incontinence, catheterization |
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==Clinical Manifestations== |
==Clinical Manifestations== |
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==Investigations== |
==Investigations== |
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*Urinalysis |
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*Urinalysis has high NPV (~100%) if negative for leukocyst esterase and nitrites |
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**Leukocyte esterase |
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**Nitrite, positive for organisms that convert nitrate to nitrite such as the Gram-negative bacteria |
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**High negative predictive value if both LE and nitrite are negative |
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*Urine microscopy |
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**Pyuria indicated by 5-10 cells per HPF |
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[[Category:Genitourinary infections]] |
[[Category:Genitourinary infections]] |
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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
- Gram-negative bacteria
- Escherichia coli, most common cause overall
- Proteus, Klebsiella, Enterobacter
- Pseudomonas, Acinetobacter
- Gram-positive bacteria
- Staphylococcus saprophyticus, more common in young women
- Enterococcus faecalis
- Staphylococcus aureus, as a complication of Staphylococcus aureus bacteremia
- Corynebacterium urealyticum
- Viruses
- 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
- 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)
- Two or more clinical symptoms:
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
References
- ^ Dimitri M. Drekonja, Barbara Trautner, Carla Amundson, Michael Kuskowski, James R. Johnson. Effect of 7 vs 14 Days of Antibiotic Therapy on Resolution of Symptoms Among Afebrile Men With Urinary Tract Infection. JAMA. 2021;326(4):324. doi:10.1001/jama.2021.9899.
