Difference between revisions of "Genitourinary infection"

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{{UTI types}}
*UTI = significant bacteriuria in presence of symptoms
**Described by location: urethritis, cystitis, or pyelonephritis
**Recurrence of symptoms w/in month despite tx
***Caused by same organism and represents treatment failure
**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)
#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)
*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
===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
**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]]
=====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]]
*Very high specificity (>90%) in confirming diagnosis of UTI
*Low sensitivity (enterococcus, pseudomonas, acinetobacter are not detected)
====[[Urine Culture]]====
*Indicated for:
**Complicated UTI
**Pregnant women
**Adult males
====[[Blood Culture]]====
*Not indicated
**Organisms in blood cx matched those in urine cx 97% of time
*Consider if [[pyelonephritis]] and any of the following:
#History of [[Renal Stone]]
#Poor response to [[antibiotics]]
#Severely ill
*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
*UTI in previous 4wk
*Age 65 yr
*Women who use spermicides or diaphragm
{{UTI Antibiotics}}
===Uncomplicated UTI===
**Unable to tolerate PO
**Consider phenazopyridine 100-200mg TID after meals x2d only (bladder analgesic)
**Consider if young, otherwise healthy, tolerating PO
**Consider if elderly, [[Renal Calculi]], obstruction, recent hospitalization/instrumentation, [[DM]]
*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==
*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==
*[[Flank pain]]
*[[UTI (Peds)]]
*[[UTI (Peds)]]
*[[Dysuria (DDX)]]
==Source ==

Revision as of 17:01, 22 March 2016


Genitourinary infection

(1) Human urinary system: (2) kidney; (3) renal pelvis; (4) ureter; (5) urinary bladder (6) urethra.
Additional structures: (7) adrenal gland; (8) renal artery and vein; (9) inferior vena cava; (10) abdominal aorta; (11) common iliac artery and vein; (12) liver; (13) large intestine; (14) pelvis.

"UTI" frequently refers specifically to acute cystitis, but may also be used as a general term for all urinary infections; use location-specific diagnosis.

See Also