Urinary Tract Infection
Evaluation
General—urinary tract infections (UTIs) include asymptomatic bacteriuria, cystitis, pyelonephritis, and urosepsis
Asymptomatic bacteriuria
Description—” class=LK href=”javascript:void(0)” target=right xpath=”/CT{06b9ee1beed59419a81e5e1e1a4f60b0cc8cd1057525de73425b2b43f4df7f1bf60323fbcd0e1aa4e5fb9c2b78c8b64b}/ID(AB1-M10)”>>100,000 colony-forming units (CFU) per mL of bacteria in voided urine with no clinical symptoms of UTI
Etiology: Escherichia coli, Staphylococcus saprophyticus, Proteus mirabilis, Klebsiella pneumoniae
Epidemiology—those patients who benefit from treatment for asymptomatic bacteriuria include
Pregnant women
Those with renal transplants
Those scheduled for a genitourinary tract procedure
Treatment—treat for 3 to 7 days using one of these agents
Note: After treatment is completed, culture urine to ensure cure and thereby avoid relapse.
Cystitis
Description—inflammation of the bladder
Clinical—urinary frequency, burning, hematuria, and suprapubic pain
Etiology—E. coli, S. saprophyticus, P. mirabilis, K. pneumoniae
Classification
Acute uncomplicated cystitis in young women
Criteria—urinalysis → pyuria (+ leukocyte esterase, + nitrite); culture not needed.
Epidemiology—those at highest risk are sexually active young women.
Treatment—treat for 3 days using one of these agents
Recurrent cystitis in young women
Criteria—recurrent UTI and a urine culture with ” class=LK href=”javascript:void(0)” target=right xpath=”/CT{06b9ee1beed59419a81e5e1e1a4f60b0cc8cd1057525de73425b2b43f4df7f1bf60323fbcd0e1aa4e5fb9c2b78c8b64b}/ID(AB1-M10)”>>100 CFU per mL of bacteria
Recurrence implies that the infection is from a different organism.
Treatment—as for acute uncomplicated cystitis, except treat for 7 to 10 days
Prevention—for those with more than three cystitis episodes per year, consider
Self-treatment with 3 days of standard therapy for each acute episode
Postcoital prophylaxis if UTIs are associated with intercourse
TMP-SMZ SS (Bactrim SS)
Daily prophylaxis (continuously for 6 months)
TMP-SMZ SS (Bactrim SS)—half tablet PO daily
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