Difference between revisions of "Genitourinary infection"

m (Rossdonaldson1 moved page Urinary tract infection to Urinary tract infections)
(Replaced content with "==Background== May refer to: *Acute cystitis *Pyelonephritis *Urethritis ==See Also== *UTI (Peds) Category:Nephro Category:ID Category:GU")
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==Background==
 
==Background==
*Also known as acute cystitis; abbreviation = UTI
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May refer to:
===Definitions===
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*[[Acute cystitis]]
*UTI = significant bacteriuria in presence of symptoms
 
**Described by location: urethritis, cystitis, or pyelonephritis
 
*Relapse
 
**Recurrence of symptoms w/in month despite tx
 
***Caused by same organism and represents treatment failure
 
*Reinfection
 
**Development of symptoms 1-6mo after tx
 
**Usually due to a different organism
 
**If pt has >3 recurrences in 1 yr consider tumor, calculi, [[diabetes]]
 
*Men <50 yr: symptoms of dysuria or urinary frequency usually due to [[STI]]
 
*Men >50 yr: incidence of UTI rises dramatically d/t prostatic obstruction
 
*Uncomplicated UTI:
 
**No structural or functional abnormalities w/in urinary tract or kidney
 
**No relevant comorbidities that place pt at risk for more serious adverse outcome
 
**Not associated with GU tract instrumentation
 
===Risk factors for complicated UTI===
 
#Male sex
 
##In young males dysuria is more commonly d/t STI
 
##Suspect underlying anatomic abnormality in men with culture-proven UTI
 
#Anatomic abnormality of urinary tract or external drainage system
 
##Indwelling urinary catheter, stent
 
##Nephrolithiasis, neurogenic bladder, polycystic renal disease, recent instrumentation
 
#Recurrent UTI (three or more per year)
 
#Advanced age in men (BPH, recent instrumentation, recent prostatic biopsy)
 
#Nursing home residency (w/ or w/o indwelling bladder catheter)
 
#Neonatal state
 
#Comorbidities ([[DM]], sickle cell disease)
 
#Pregnancy
 
#Immunosuppression ([[AIDS]], immunosuppressive drugs)
 
#Advanced neurologic disease ([[CVA]] w/ disability, [[Spinal Cord Injuries]])
 
#Known or suspected atypical pathogens (Non–E. coli infection)
 
#Known or suspected abx resistance (resistance to Cipro predicts multidrug resistance)
 
 
 
===[[Microbiology]]===
 
*Most common pathogen is [[E. coli]]
 
*[[Anaerobic]] organisms are rarely pathogenic (do not grow well in urine)
 
*Complicated UTIs more likely to be caused by [[pseudomonas]] or [[enterococcus]]
 
 
 
==Diagnosis==
 
===Clinical Features===
 
*UTI dx requires both bacteriuria and clinical symptoms
 
**Cystitis = Dysuria, [[hematuria]], frequency, urgency, suprapubic pain, CVAT
 
**Pyelo = Cystitis sx AND fever/chills/nausea/vomiting
 
***CVAT alone may be referred pain from cystitis
 
***CVAT is only physical examination finding that increases likelihood of a UTI
 
*Urethritis
 
**In males more likely due to [[chlamydia]]/[[GC]]
 
**In females more likely due to [[chlam]]/[[GC]] if:
 
***Stuttering urination symptoms
 
***New sex partner or partner w/ urethritis
 
***Signs/symptoms cervicitis
 
***Sterile pyuria
 
*Complicated UTI
 
**Pts may not have classic symptoms; may only have [[weakness]], [[fever]], [[abd pain]], [[AMS]]
 
===Labs===
 
====UA====
 
=====WBC count=====
 
*WBC >5 in pt w/ appropriate symptoms is diagnostic
 
**Lower degrees of pyuria may still be clinically significant in presence of UTI sx
 
***False negative may be due to: dilute urine, systemic leukopenia, obstruction
 
**WBC 1-2 w/ bacteriuria can be significant in men
 
***More likely represents urethritis or [[prostatitis]] from [[STI]]
 
 
 
=====Nitrite=====
 
*Very high specificity (>90%) in confirming diagnosis of UTI
 
*Low sensitivity (enterococcus, pseudomonas, acinetobacter are not detected)
 
====[[Urine Culture]]====
 
*Indicated for:
 
**Complicated UTI
 
**Pyelonephritis
 
**Pregnant women
 
**Children
 
**Adult males
 
**Relapse/reinfection
 
====[[Blood Culture]]====
 
*Not indicated
 
**Organisms in blood cx matched those in urine cx 97% of time
 
 
 
===Imaging===
 
*Consider if [[pyelonephritis]] and any of the following:
 
#History of [[Renal Stone]]
 
#Poor response to [[antibiotics]]
 
#Male
 
#Elderly
 
#[[Diabetic]]
 
#Severely ill
 
 
 
==Differential Diagnosis==
 
===Major===
 
 
*[[Pyelonephritis]]
 
*[[Pyelonephritis]]
*Infected [[kidney stone]]
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*[[Urethritis]]
 
 
===Pelvic Pain===
 
{{Pelvic pain DDX}}
 
 
 
===Dysuria===
 
{{Dysuria DDX}}
 
 
 
==Management==
 
*Consider local resistance patterns (if >10-20% use a different agent)
 
*Avoid use of fluoroquinolones for uncomplicated cystitis if possible
 
 
 
;Consider longer course of complicated cystitis if:
 
*Symptoms >7d
 
*[[DM]]
 
*UTI in previous 4wk
 
*Men
 
*Age 65 yr
 
*Women who use spermicides or diaphragm
 
*Relapse
 
*Pregnancy
 
 
 
{{UTI Antibiotics}}
 
 
 
==Disposition==
 
===Uncomplicated UTI===
 
*Admit
 
**Unable to tolerate PO
 
*Discharge
 
**Consider phenazopyridine 100-200mg TID after meals x2d only (bladder analgesic)
 
===[[Pyelonephritis]]===
 
*Discharge
 
**Consider if young, otherwise healthy, tolerating PO
 
*Admission
 
**Consider if elderly, [[Renal Calculi]], obstruction, recent hospitalization/instrumentation, [[DM]]
 
 
 
==Complications==
 
*Suspect in pts who have inadequate or atypical response to tx for presumed [[pyelonephritis]]
 
#Acute bacterial nephritis
 
##CT shows ill-defined focal areas of decreased density
 
#Renal/Perinephric Abscesses
 
##Sign/symptoms similar to [[pyelo]] ([[fever]], CVAT, dysuria)
 
##Occurs in setting of ascending infection w/ obstructed pyelo
 
##Associated w/ [[DM]] and [[Renal Stones]]
 
##Also occurs due to bacteremia w/ hematogenous seeding (Staph)
 
#Emphysematous pyelonephritis
 
##Rare gas-forming infection nearly always occurring in pts w/ [[DM]] and obstruction
 
###Pts appear toxic and [[septic]]; nephrectomy may be required
 
 
 
==Special Populations==
 
===[[AIDS]]===
 
*[[TMP-SMX]] resistance is increased due to its use in [[PCP PNA]] prophylaxis
 
**[[Fluoroquinolones]] should be initial antibiotic of choice
 
*Most UTIs are caused by typical pathogens or common STI organisms
 
===Pregnant Women===
 
*Treat all cases of asymptomatic bacteriuria
 
  
 
==See Also==
 
==See Also==
 
*[[UTI (Peds)]]
 
*[[UTI (Peds)]]
*[[Dysuria]]
 
 
==Source ==
 
Tintinalli
 
  
 
[[Category:Nephro]]
 
[[Category:Nephro]]
 
[[Category:ID]]
 
[[Category:ID]]
 
[[Category:GU]]
 
[[Category:GU]]

Revision as of 13:04, 22 February 2015

Background

May refer to:

See Also