Urinary tract infection: Difference between revisions

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==Classification==
==Classification==
Urinary tract infections can be classified as follows:
Urinary tract infections can be classified as follows:
 
=== Anatomical Classification ===
{{familytree/start}}
{{familytree/start}}
{{familytree | | | | | | | | | | | | | A01 | | | | | | | | | | | | | | | | | |A01= Urinary tract infections}}
{{familytree | | | | | | | | | | | | | A01 | | | | | | | | | | | | | | | | | |A01= Urinary tract infections}}
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{{familytree | | | | |!| | | | |!| | | | | | | | | |!| | | | | | | | | | | | | | | }}
{{familytree | | | | |!| | | | |!| | | | | | | | | |!| | | | | | | | | | | | | | | }}
{{familytree | | | | |!| | | | |!| | | | | | | | | |!| | | | | | | | | | | | }}
{{familytree | | | | |!| | | | |!| | | | | | | | | |!| | | | | | | | | | | | }}
{{familytree |boxstyle=text-align: left; | | | | D01 | | | D02 | | | | | | | | D03 | | | | | | | | | | D01 = • Acute uncomplicated<br>• Acute complicated <br>• Chronic <br>•  Emphysematous <br>• Xantho-granulomatous| D02 = • Acute uncomplicated<br>• Complicated<br>• Recurrent/chronic | D03 = • Acute bacterial <br> • Chronic bacterial <br>• Chronic inflammatory<br>• Chronic non-inflammatory <br>• Asymptomatic }}
{{familytree |boxstyle=text-align: left; | | | | D01 | | | D02 | | | | | | | | D03 | | | | | | | | | | D01 = • Acute uncomplicated<br>• Acute complicated <br>• Chronic <br>•Emphysematous <br>• Xantho-granulomatous| D02 = • Acute uncomplicated<br>• Complicated<br>•Recurrent/chronic | D03 = • Acute bacterial<br>• Chronic bacterial<br>• Chronic inflammatory<br>• Chronic non-inflammatory<br>•Asymptomatic }}
{{familytree/end}}
{{familytree/end}}
=== Classification Based on Symptoms ===
This classification is primarily used to estimate duration of antibiotic treatment.<ref name="pmid18242357">{{cite journal| author=Peterson J, Kaul S, Khashab M, Fisher AC, Kahn JB| title=A double-blind, randomized comparison of levofloxacin 750 mg once-daily for five days with ciprofloxacin 400/500 mg twice-daily for 10 days for the treatment of complicated urinary tract infections and acute pyelonephritis. | journal=Urology | year= 2008 | volume= 71 | issue= 1 | pages= 17-22 | pmid=18242357 | doi=10.1016/j.urology.2007.09.002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18242357  }} </ref>
{{Family tree/start}}•
{{Family tree | | | | A01 | | | |A01= UTI}}
{{Family tree | | | | |!| | | | | }}
{{familytree |boxstyle=text-align: left; | | | | B01 | | | |B01= • [[Fever]] > 99.9 F OR<br> • [[Flank pain]] or [[CVA tenderness]] with [[pyuria]] OR<br> • [[Fever]] with [[pyuria]] OR<br> • [[Sepsis]] OR<br> • Systemic signs such as chills, rigors, fatigue OR<br> • UTI in men OR<br> • Anatomical renal defects OR}}
{{Family tree | |,|-|-|^|-|-|.| | }}
{{Family tree | C01 | | | | C02 |C01= Present  (anyone)| C02= Absent}}
{{Family tree | |!| | | | | |!| | }}
{{Family tree | D01 | | | | D02 |D01= Treat as complicated UTI <br> • 5 - 14 days based on choice of antibiotics| D02= Treat as uncomplicated UTI <br> • 5 days}}
{{Family tree/end}}


==Causes==
==Causes==
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! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Asymptomatic  Bacteriuria
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Asymptomatic  Bacteriuria
|-
|-
! style="background: #4479BA; color: #FFFFFF; text-align: left;" |Ecoli*<ref>{{Cite journal
! align="left" style="background:#DCDCDC;" + |Ecoli*<ref>{{Cite journal
  | author = [[R. M. Echols]], [[R. L. Tosiello]], [[D. C. Haverstock]] & [[A. D. Tice]]
  | author = [[R. M. Echols]], [[R. L. Tosiello]], [[D. C. Haverstock]] & [[A. D. Tice]]
  | title = Demographic, clinical, and treatment parameters influencing the outcome of acute cystitis
  | title = Demographic, clinical, and treatment parameters influencing the outcome of acute cystitis
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  | pmid = 20444967
  | pmid = 20444967
}}</ref>
}}</ref>
| align="center" style="background:#F5F5F5;" + |+ (70%)
| align="center" style="background:#F5F5F5;" + | + (70%)
| align="center" style="background:#F5F5F5;" + |+ (78.6%)
| align="center" style="background:#F5F5F5;" + | + (78.6%)
| align="center" style="background:#F5F5F5;" + |–
| align="center" style="background:#F5F5F5;" + |–
| align="center" style="background:#F5F5F5;" + |+ (58%)
| align="center" style="background:#F5F5F5;" + | + (58%)
| align="center" style="background:#F5F5F5;" + |+ (80%)
| align="center" style="background:#F5F5F5;" + | + (80%)
|-
|-
! style="background: #4479BA; color: #FFFFFF; text-align: left;" |Klebsiella<ref>{{Cite journal
! align="left" style="background:#DCDCDC;" + |Klebsiella<ref>{{Cite journal
  | author = [[R. M. Echols]], [[R. L. Tosiello]], [[D. C. Haverstock]] & [[A. D. Tice]]
  | author = [[R. M. Echols]], [[R. L. Tosiello]], [[D. C. Haverstock]] & [[A. D. Tice]]
  | title = Demographic, clinical, and treatment parameters influencing the outcome of acute cystitis
  | title = Demographic, clinical, and treatment parameters influencing the outcome of acute cystitis
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| align="center" style="background:#F5F5F5;" + | +  
| align="center" style="background:#F5F5F5;" + | +  
|-
|-
! style="background: #4479BA; color: #FFFFFF; text-align: left;" |Proteus<ref>{{Cite journal
! align="left" style="background:#DCDCDC;" + |Proteus<ref>{{Cite journal
  | author = [[R. M. Echols]], [[R. L. Tosiello]], [[D. C. Haverstock]] & [[A. D. Tice]]
  | author = [[R. M. Echols]], [[R. L. Tosiello]], [[D. C. Haverstock]] & [[A. D. Tice]]
  | title = Demographic, clinical, and treatment parameters influencing the outcome of acute cystitis
  | title = Demographic, clinical, and treatment parameters influencing the outcome of acute cystitis
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| align="center" style="background:#F5F5F5;" + |–
| align="center" style="background:#F5F5F5;" + |–
| align="center" style="background:#F5F5F5;" + | +  
| align="center" style="background:#F5F5F5;" + | +  
| align="center" style="background:#F5F5F5;" + |+  
| align="center" style="background:#F5F5F5;" + | +  
|-
|-
! style="background: #4479BA; color: #FFFFFF; text-align: left;" |Neisseria gonorrhoeae<ref>{{Cite journal
! align="left" style="background:#DCDCDC;" + |Neisseria gonorrhoeae<ref>{{Cite journal
  | author = [[Stephanie N. Taylor]], [[Oliver Liesenfeld]], [[Rebecca A. Lillis]], [[Barbara A. Body]], [[Melinda Nye]], [[James Williams]], [[Carol Eisenhut]], [[Edward W. 3rd Hook]] & [[Barbara Van Der Pol]]
  | author = [[Stephanie N. Taylor]], [[Oliver Liesenfeld]], [[Rebecca A. Lillis]], [[Barbara A. Body]], [[Melinda Nye]], [[James Williams]], [[Carol Eisenhut]], [[Edward W. 3rd Hook]] & [[Barbara Van Der Pol]]
  | title = Evaluation of the Roche cobas(R) CT/NG test for detection of Chlamydia trachomatis and Neisseria gonorrhoeae in male urine
  | title = Evaluation of the Roche cobas(R) CT/NG test for detection of Chlamydia trachomatis and Neisseria gonorrhoeae in male urine
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| align="center" style="background:#F5F5F5;" + |–
| align="center" style="background:#F5F5F5;" + |–
|-
|-
! style="background: #4479BA; color: #FFFFFF; text-align: left;" |Pseudomonas<ref>{{Cite journal
! align="left" style="background:#DCDCDC;" + |Pseudomonas<ref>{{Cite journal
  | author = [[Allan Ronald]]
  | author = [[Allan Ronald]]
  | title = The etiology of urinary tract infection: traditional and emerging pathogens
  | title = The etiology of urinary tract infection: traditional and emerging pathogens
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| align="center" style="background:#F5F5F5;" + | +  
| align="center" style="background:#F5F5F5;" + | +  
|-
|-
! style="background: #4479BA; color: #FFFFFF; text-align: left;" |Staphylococcus
! align="left" style="background:#DCDCDC;" + |Staphylococcus
| align="center" style="background:#F5F5F5;" + | +  
| align="center" style="background:#F5F5F5;" + | +  
| align="center" style="background:#F5F5F5;" + | +  
| align="center" style="background:#F5F5F5;" + | +  
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| align="center" style="background:#F5F5F5;" + | +  
| align="center" style="background:#F5F5F5;" + | +  
|-
|-
! style="background: #4479BA; color: #FFFFFF; text-align: left;" |Chlamydia trachomatis<ref>{{Cite journal
! align="left" style="background:#DCDCDC;" + |Chlamydia trachomatis<ref>{{Cite journal
  | author = [[J. Dimitrakov]], [[V. Ganev]], [[T. Zlatanov]], [[I. Detchev]], [[A. Horvat]], [[S. Kirov]], [[I. Vatchkova]] & [[D. Dimitrakov]]
  | author = [[J. Dimitrakov]], [[V. Ganev]], [[T. Zlatanov]], [[I. Detchev]], [[A. Horvat]], [[S. Kirov]], [[I. Vatchkova]] & [[D. Dimitrakov]]
  | title = PCR studies on the presence of Chlamydia trachomatis in the upper urinary tract of patients with obstructive pyelonephritis
  | title = PCR studies on the presence of Chlamydia trachomatis in the upper urinary tract of patients with obstructive pyelonephritis
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| align="center" style="background:#F5F5F5;" + |–
| align="center" style="background:#F5F5F5;" + |–
|-
|-
! style="background: #4479BA; color: #FFFFFF; text-align: left;" |Mycoplasma<ref>{{Cite journal
! align="left" style="background:#DCDCDC;" + |Mycoplasma<ref>{{Cite journal
  | author = [[Iu L. Naboka]], [[L. I. Vasil'eva]], [[M. I. Kogan]], [[I. A. Gudima]] & [[I. Iu Suchkov]]
  | author = [[Iu L. Naboka]], [[L. I. Vasil'eva]], [[M. I. Kogan]], [[I. A. Gudima]] & [[I. Iu Suchkov]]
  | title = &#91;Microbial associations defecting in children with chronic pyelonephritis&#93;
  | title = &#91;Microbial associations defecting in children with chronic pyelonephritis&#93;
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  | pmid = 20063785
  | pmid = 20063785
}}</ref>
}}</ref>
| align="center" style="background:#F5F5F5;" + |+  
| align="center" style="background:#F5F5F5;" + | +  
| align="center" style="background:#F5F5F5;" + |–
| align="center" style="background:#F5F5F5;" + |–
| align="center" style="background:#F5F5F5;" + |+  
| align="center" style="background:#F5F5F5;" + | +  
| align="center" style="background:#F5F5F5;" + |–
| align="center" style="background:#F5F5F5;" + |–
| align="center" style="background:#F5F5F5;" + |–
| align="center" style="background:#F5F5F5;" + |–
|-
|-
! style="background: #4479BA; color: #FFFFFF; text-align: left;" |Trichomonas<ref>{{Hoffman, David J., et al. "Urinary tract infection with Trichomonas vaginalis in a premature newborn infant and the development of chronic lung disease." Journal of perinatology 23.1 (2003): 59-61.}}</ref><ref>{{Cite journal
! align="left" style="background:#DCDCDC;" + |Trichomonas<ref>{{Hoffman, David J., et al. "Urinary tract infection with Trichomonas vaginalis in a premature newborn infant and the development of chronic lung disease." Journal of perinatology 23.1 (2003): 59-61.}}</ref><ref>{{Cite journal
  | author = [[L. SYLVESTRE]], [[M. BELANGER]] & [[Z. GALLAI]]
  | author = [[L. SYLVESTRE]], [[M. BELANGER]] & [[Z. GALLAI]]
  | title = Urogenital trichomoniasis in the male: review of the literature and report on treatment of 37 patients by a new nitroimidazole derivative (Flagyl)
  | title = Urogenital trichomoniasis in the male: review of the literature and report on treatment of 37 patients by a new nitroimidazole derivative (Flagyl)
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|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="2" |<small>Diseases</small>
! rowspan="2" |<small>Diseases</small>
| colspan="5" |<small>'''Symptoms'''
! colspan="4" |<small>Physical Examination</small>
! colspan="3" |<small>Diagnostic tests</small>
! colspan="3" |<small>Diagnostic tests</small>
! colspan="4" |<small>Physical Examination</small>
| colspan="5" |<small>Symptoms
! colspan="1" rowspan="2" |<small>Past medical history</small>
! colspan="1" rowspan="2" |<small>Past medical history</small>
! rowspan="2" |<small>Other Findings</small>
! rowspan="2" |<small>Other Findings</small>
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
!<small>Urinalysis</small>
!<small>Urine Culture</small>
!<small>Gold Standard
!<small>Fever</small>
!<small>Tenderness</small>
!<small>Discharge</small>
!<small>Inguinal Lymphadenopathy</small>
!<small>Hematuria</small>
!<small>Hematuria</small>
!<small>Pyuria</small>
!<small>Pyuria</small>
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!<small>Urgency</small>
!<small>Urgency</small>
!<small>Dysuria</small>
!<small>Dysuria</small>
!<small>Fever</small>
!<small>Tenderness</small>
!<small>Discharge</small>
!<small>Inguinal Lymphadenopathy</small>
!<small>Urinalysis</small>
!<small>Urine Culture</small>
!<small>Gold Standard
|-
|-
| colspan="4" |'''Differentiating amongst different types of Urinary Tract Infections:'''
| colspan="15" |'''Differentiating amongst different types of urinary tract infections:'''
| colspan="11" |
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Pyelonephritis]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Pyelonephritis|'''Pyelonephritis''']]
| align="left" style="background:#F5F5F5;" + |
*[[Leukocytes]]
*[[Nitrite test|Nitrite]] +ve
| align="center" style="background:#F5F5F5;" + |Identifies causative [[bacteria]]
| align="center" style="background:#F5F5F5;" + |Imaging and culture
| align="center" style="background:#F5F5F5;" + | +  
| align="center" style="background:#F5F5F5;" + | +  
| align="center" style="background:#F5F5F5;" + |[[Flank pain|Flank]] or [[costovertebral angle]]
| align="center" style="background:#F5F5F5;" + | +  
| align="center" style="background:#F5F5F5;" + | +  
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |+
| align="center" style="background:#F5F5F5;" + |+
| align="center" style="background:#F5F5F5;" + |–
| align="center" style="background:#F5F5F5;" + |–
| align="center" style="background:#F5F5F5;" + |–
| align="center" style="background:#F5F5F5;" + |–
| align="center" style="background:#F5F5F5;" + |+  
| align="center" style="background:#F5F5F5;" + | +  
| align="center" style="background:#F5F5F5;" + |  +
| align="center" style="background:#F5F5F5;" + | [[Flank pain|Flank]] or [[costovertebral angle]]
| align="center" style="background:#F5F5F5;" + |  +
| align="center" style="background:#F5F5F5;" + |  +
| align="left" style="background:#F5F5F5;" + |
*[[Leukocytes]]
*[[Nitrite test|Nitrite]] +ve
| align="center" style="background:#F5F5F5;" + | Identifies causative [[bacteria]]
| align="center" style="background:#F5F5F5;" + | [[Urine culture]]
| align="left" style="background:#F5F5F5;" + |
| align="left" style="background:#F5F5F5;" + |
* History of [[pyelonephritis]]
* History of [[pyelonephritis]]
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* Look for obstructive causes
* Look for obstructive causes
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" | [[Cystitis]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" | [[Cystitis|'''Cystitis''']]
| align="left" style="background:#F5F5F5;" + |
*[[Nitrite test|Nitrite]] +ve
*[[Leukocyte esterase]]+ve
*[[White blood cells|WBCs]]
*[[RBCs]]
| align="center" style="background:#F5F5F5;" + |>100,000CFU/mL
| align="center" style="background:#F5F5F5;" + |[[Urine culture]]
| align="center" style="background:#F5F5F5;" + | +  
| align="center" style="background:#F5F5F5;" + | +  
| align="center" style="background:#F5F5F5;" + |Suprapubic
| align="center" style="background:#F5F5F5;" + | –
| align="center" style="background:#F5F5F5;" + | +  
| align="center" style="background:#F5F5F5;" + | +  
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |+
| align="center" style="background:#F5F5F5;" + | +  
| align="center" style="background:#F5F5F5;" + | +  
| align="center" style="background:#F5F5F5;" + | +  
| align="center" style="background:#F5F5F5;" + | +  
| align="center" style="background:#F5F5F5;" + | +  
| align="center" style="background:#F5F5F5;" + | +  
| align="center" style="background:#F5F5F5;" + |  +
| align="center" style="background:#F5F5F5;" + | Suprapubic
| align="center" style="background:#F5F5F5;" + | –
| align="center" style="background:#F5F5F5;" + | +
| align="left" style="background:#F5F5F5;" + |
*[[Nitrite test|Nitrite]] +ve
*[[Leukocyte esterase]] +ve
*[[White blood cells|WBCs]]
*[[RBCs]]
| align="center" style="background:#F5F5F5;" + | >100,000CFU/mL
| align="center" style="background:#F5F5F5;" + | [[Urine culture]]
| align="left" style="background:#F5F5F5;" + |
| align="left" style="background:#F5F5F5;" + |
*Recent catheterisation
*Recent catheterisation
*[[Pregnancy]]
*[[Pregnancy]]
*recent intercourse
*Recent intercourse
*[[Diabetes]]
*[[Diabetes]]
*Personal or [[family history]] of [[UTI]]
*Personal or [[family history]] of [[UTI]]
*Known abnormality of the [[urinary tract]]
*Known abnormality of the [[urinary tract]]
*[[BPH]] or [[HIV]]
*[[BPH]]
*[[HIV]]
| align="left" style="background:#F5F5F5;" + |
| align="left" style="background:#F5F5F5;" + |
* Imaging studies help differentiate the various types
* Imaging studies help differentiate the various types
* May accompany [[back pain]], [[nausea]], [[vomiting]], and [[chills]]
* May accompany [[back pain]], [[nausea]], [[vomiting]], and [[chills]]
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Urethritis]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Urethritis|'''Urethritis''']]
| align="left" style="background:#F5F5F5;" + |
*Positive [[leukocyte esterase]] test or >10 [[White blood cells|WBCs]]
*Mucous threads in the morning [[urine]]
| align="center" style="background:#F5F5F5;" + | –
| align="center" style="background:#F5F5F5;" + |
[[Gram stain]] & mucoid or [[purulent]] [[discharge]]
| align="center" style="background:#F5F5F5;" + |+
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |[[Urethral discharge]]
| align="center" style="background:#F5F5F5;" + |+
| align="center" style="background:#F5F5F5;" + | –
| align="center" style="background:#F5F5F5;" + | –
| align="center" style="background:#F5F5F5;" + | +   
| align="center" style="background:#F5F5F5;" + | +   
Line 354: Line 357:
| align="center" style="background:#F5F5F5;" + | –
| align="center" style="background:#F5F5F5;" + | –
| align="center" style="background:#F5F5F5;" + | +  
| align="center" style="background:#F5F5F5;" + | +  
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | –
| align="center" style="background:#F5F5F5;" + | [[Urethral discharge]]
| align="center" style="background:#F5F5F5;" + |  +
| align="left" style="background:#F5F5F5;" + |
*Positive [[leukocyte esterase]] test or >10 [[White blood cells|WBCs]]
*Mucous threads in the morning [[urine]]
| align="center" style="background:#F5F5F5;" + | –
| align="center" style="background:#F5F5F5;" + | [[Gram stain]] & mucoid or [[purulent]] [[discharge]]
| align="left" style="background:#F5F5F5;" + |
| align="left" style="background:#F5F5F5;" + |
* Prior [[STD]]s
* Prior [[STD]]s
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*Painful genital [[ulcers]] with [[dysuria]] suggest [[HSV]]
*Painful genital [[ulcers]] with [[dysuria]] suggest [[HSV]]
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Prostatitis]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Prostatitis|'''Prostatitis''']]
| align="left" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + | –
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | –
| align="center" style="background:#F5F5F5;" + | –
| align="center" style="background:#F5F5F5;" + | –
| align="left" style="background:#F5F5F5;" + |  
*10–20 [[leukocytes]] for acute and chronic [[bacterial]] subtypes
*10–20 [[leukocytes]] for acute and chronic [[bacterial]] subtypes
| align="center" style="background:#F5F5F5;" + |Identifies causative [[bacteria]] (in [[bacterial]] subtypes)
| align="center" style="background:#F5F5F5;" + | Identifies causative [[bacteria]] (in [[bacterial]] subtypes)
| align="center" style="background:#F5F5F5;" + |  
| align="center" style="background:#F5F5F5;" + | [[Urine culture]]
[[Urine culture]]  
| align="center" style="background:#F5F5F5;" + |+
| align="center" style="background:#F5F5F5;" + |–
| align="center" style="background:#F5F5F5;" + | –
| align="center" style="background:#F5F5F5;" + |–
| align="center" style="background:#F5F5F5;" + |–
| align="center" style="background:#F5F5F5;" + |+
| align="center" style="background:#F5F5F5;" + |+
| align="center" style="background:#F5F5F5;" + |+
| align="center" style="background:#F5F5F5;" + |+
| align="left" style="background:#F5F5F5;" + |
| align="left" style="background:#F5F5F5;" + |
* [[Urogenital]] disorders
* [[Urogenital]] disorders
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* History of [[UTI|UTIs]]
* History of [[UTI|UTIs]]
| align="left" style="background:#F5F5F5;" + |
| align="left" style="background:#F5F5F5;" + |
* In [[acute prostatitis]], [[palpation]] reveals a [[Tenderness|tender]] and [[enlarged prostate]]<sup>[[Prostatitis physical examination|[1][3]]]</sup>
*[[Tenderness|Tender]] and [[enlarged prostate]] in [[acute prostatitis]]<sup>[[Prostatitis physical examination|[1][3]]]</sup>
* In chronic [[prostatitis]], [[palpation]] reveals a tender and soft (boggy) [[prostate]]<sup>[[Prostatitis physical examination|[1]]]</sup>
*Tender and soft (boggy) [[prostate]] in chronic [[prostatitis]]<sup>[[Prostatitis physical examination|[1]]]</sup>
* A [[prostate massage]] should never be done in a patient with suspected [[acute prostatitis]], since it may induce [[sepsis]]
* A [[prostate massage]] should never be done in a patient with suspected [[acute prostatitis]], since it may induce [[sepsis]].
|-
|-
| colspan="3" |'''Differentiating UTIs from Other Diseases:'''
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
| colspan="12" |
! rowspan="2" |<small>Diseases</small>
| colspan="5" |<small>'''Symptoms'''
! colspan="4" |<small>Physical Examination</small>
! colspan="3" |<small>Diagnostic tests</small>
! colspan="1" rowspan="2" |<small>Past medical history</small>
! rowspan="2" |<small>Other Findings</small>
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
!<small>Hematuria</small>
!<small>Pyuria</small>
!<small>Frequency</small>
!<small>Urgency</small>
!<small>Dysuria</small>
!<small>Fever</small>
!<small>Tenderness</small>
!<small>Discharge</small>
!<small>Inguinal Lymphadenopathy</small>
!<small>Urinalysis</small>
!<small>Urine Culture</small>
!<small>Gold Standard
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" | [[Vulvovagintis]]
| colspan="15" |'''Differentiating UTIs from other diseases:'''
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" | [[Vulvovagintis|'''Vulvovagintis''']]
| align="center" style="background:#F5F5F5;" + |–
| align="center" style="background:#F5F5F5;" + |–
| align="center" style="background:#F5F5F5;" + |–
| align="center" style="background:#F5F5F5;" + |–
| align="center" style="background:#F5F5F5;" + |[[Gram stain]] & [[culture]] of discharge
| align="center" style="background:#F5F5F5;" + |+
| align="center" style="background:#F5F5F5;" + |–
| align="center" style="background:#F5F5F5;" + |–
| align="center" style="background:#F5F5F5;" + |–
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | –
| align="center" style="background:#F5F5F5;" + |[[Vaginal discharge]] 
| align="center" style="background:#F5F5F5;" + |[[Vaginal discharge]] 
| align="center" style="background:#F5F5F5;" + |+  
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |–
| align="center" style="background:#F5F5F5;" + | –
| align="center" style="background:#F5F5F5;" + |–
| align="center" style="background:#F5F5F5;" + | –
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + | [[Gram stain]] & [[culture]] of discharge
| align="center" style="background:#F5F5F5;" + |–
| align="center" style="background:#F5F5F5;" + |+
| align="left" style="background:#F5F5F5;" + |
| align="left" style="background:#F5F5F5;" + |
* Number and type of sexual partners (new, casual, or regular)
* Number and type of sexual partners (new, casual, or regular)
Line 415: Line 446:
* Clue cells
* Clue cells
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" | [[Cervicitis]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" | [[Cervicitis|'''Cervicitis''']]
| style="background: #F5F5F5; padding: 5px; text-align:center" |–
| align="center" style="background:#F5F5F5;" + | –
| style="background: #F5F5F5; padding: 5px; text-align:center" |
| align="center" style="background:#F5F5F5;" + | +
| style="background: #F5F5F5; padding: 5px; text-align:center" |[[Culture]] for [[gonococcal]] cervicitis
| align="center" style="background:#F5F5F5;" + |
| style="background: #F5F5F5; padding: 5px; text-align:center" | +
| align="center" style="background:#F5F5F5;" + |
| style="background: #F5F5F5; padding: 5px; text-align:center" |Cervical
| align="center" style="background:#F5F5F5;" + | +
| style="background: #F5F5F5; padding: 5px; text-align:center" |Endocervical exudate
| align="center" style="background:#F5F5F5;" + | +
| style="background: #F5F5F5; padding: 5px; text-align:center" |
| align="center" style="background:#F5F5F5;" + | Cervical
| style="background: #F5F5F5; padding: 5px; text-align:center" |
| align="center" style="background:#F5F5F5;" + | Endocervical exudate
| align="center" style="background:#F5F5F5;" + |+
| align="center" style="background:#F5F5F5;" + |
| style="background: #F5F5F5; padding: 5px; text-align:center" |–
| align="center" style="background:#F5F5F5;" + | –
| style="background: #F5F5F5; padding: 5px; text-align:center" |–
| align="center" style="background:#F5F5F5;" + | –
| align="center" style="background:#F5F5F5;" + |+
| align="center" style="background:#F5F5F5;" + | [[Culture]] for [[gonococcal]] cervicitis
| style="background: #F5F5F5; padding: 5px; text-align:left" |
| align="left" style="background:#F5F5F5;" + |
* Abnormal [[vaginal bleeding]] after intercourse or after [[menopause]]
* Abnormal [[vaginal bleeding]] after intercourse or after [[menopause]]
* Abnormal [[vaginal discharge]]
* Abnormal [[vaginal discharge]]
Line 436: Line 467:
*[[Purulent]] or [[mucopurulent]] endocervical exudate
*[[Purulent]] or [[mucopurulent]] endocervical exudate
*Sustained endocervical [[bleeding]] easily induced by a cotton swab  
*Sustained endocervical [[bleeding]] easily induced by a cotton swab  
*>10 [[WBC]] in vaginal fluid, in the absence of [[trichomoniasis]], may indicate endocervical [[inflammation]] caused specifically by [[C. trachomatis]] or [[N. gonorrhea]]
*>10 [[WBC]] in vaginal fluid, in the absence of [[trichomoniasis]], may indicate endocervical [[inflammation]] caused specifically by ''[[C. trachomatis]]'' or ''[[N. gonorrhea]]''
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Epididymitis]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Epididymitis|'''Epididymitis''']]
| align="left" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + | +  
*[[Hematuria]] may be seen
| align="center" style="background:#F5F5F5;" + |+
| align="center" style="background:#F5F5F5;" + |[[Culture]]
| align="center" style="background:#F5F5F5;" + |+
| align="center" style="background:#F5F5F5;" + |[[Testicular]] & suprapubic
| align="center" style="background:#F5F5F5;" + |+/– [[urethral discharge]]
| align="center" style="background:#F5F5F5;" + |+ 
| align="center" style="background:#F5F5F5;" + |+  
| align="center" style="background:#F5F5F5;" + | –
| align="center" style="background:#F5F5F5;" + | –
| align="center" style="background:#F5F5F5;" + |+
| align="center" style="background:#F5F5F5;" + | +  
| align="center" style="background:#F5F5F5;" + | +  
| align="center" style="background:#F5F5F5;" + |+  
| align="center" style="background:#F5F5F5;" + | +  
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | [[Testicular]] & suprapubic
| align="center" style="background:#F5F5F5;" + | +/– [[urethral discharge]]
| align="center" style="background:#F5F5F5;" + | +
| align="left" style="background:#F5F5F5;" + |
*[[Hematuria]] may be seen
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | [[Culture]]
| align="left" style="background:#F5F5F5;" + |
| align="left" style="background:#F5F5F5;" + |
*Unilateral, gradual, and [[Localized disease|localized]] [[scrotal pain]] posterior to the [[testis]]
*Unilateral, gradual, and [[Localized disease|localized]] [[scrotal pain]] posterior to the [[testis]]
Line 461: Line 492:
*If equivocal do surgical exploration
*If equivocal do surgical exploration
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Syphilis]] ([[STDs|STD]])
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Syphilis]]'''
| style="background: #F5F5F5; padding: 5px;" | –
'''([[STDs|STD]])'''
| style="background: #F5F5F5; padding: 5px;" | –
| align="center" style="background:#F5F5F5;" + | –
| style="background: #F5F5F5; padding: 5px;" |[[Dark field microscopy|Darkfield microscopy]]
| align="center" style="background:#F5F5F5;" + | –
| style="background: #F5F5F5; padding: 5px;" | +/
| align="center" style="background:#F5F5F5;" + |
| style="background: #F5F5F5; padding: 5px;" |–
| align="center" style="background:#F5F5F5;" + | –
| style="background: #F5F5F5; padding: 5px;" | –
| align="center" style="background:#F5F5F5;" + | –
| style="background: #F5F5F5; padding: 5px;" | +
| align="center" style="background:#F5F5F5;" + | +/
| style="background: #F5F5F5; padding: 5px;" | –
| align="center" style="background:#F5F5F5;" + |
| style="background: #F5F5F5; padding: 5px;" |
| align="center" style="background:#F5F5F5;" + | –
| style="background: #F5F5F5; padding: 5px;" | –
| align="center" style="background:#F5F5F5;" + | +
| style="background: #F5F5F5; padding: 5px;" |–
| align="center" style="background:#F5F5F5;" + | –
| style="background: #F5F5F5; padding: 5px;" |
| align="center" style="background:#F5F5F5;" + | –
| style="background: #F5F5F5; padding: 5px;" |
| align="center" style="background:#F5F5F5;" + | [[Dark field microscopy|Darkfield microscopy]]
| align="left" style="background:#F5F5F5;" + |  
* History of [[STD]]
* History of [[STD]]
* [[HIV AIDS|HIV]]
* [[HIV AIDS|HIV]]
* [[Immunosupression]]
* [[Immunosupression]]
* Previous history of [[chancre]]
* Previous history of [[chancre]]
| style="background: #F5F5F5; padding: 5px;" |
| align="left" style="background:#F5F5F5;" + |  
* May be asymptomatic
* May be asymptomatic
* Painless [[chancre]] in [[primary syphilis]]
* Painless [[chancre]] in [[primary syphilis]]
Line 485: Line 517:
* [[Tertiary syphilis]] can have [[neurosyphilis]], [[cardiovascular syphilis]] and gummas
* [[Tertiary syphilis]] can have [[neurosyphilis]], [[cardiovascular syphilis]] and gummas
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[BPH]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[BPH|'''BPH''']]
| style="background: #F5F5F5; padding: 5px;" |
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | –
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | –
| align="center" style="background:#F5F5F5;" + | –
| align="center" style="background:#F5F5F5;" + | –
| align="center" style="background:#F5F5F5;" + | –
| align="left" style="background:#F5F5F5;" + |  
*[[Hematuria]] may be seen
*[[Hematuria]] may be seen
| style="background: #F5F5F5; padding: 5px;" |–
| align="center" style="background:#F5F5F5;" + | –
| style="background: #F5F5F5; padding: 5px;" |
| align="center" style="background:#F5F5F5;" + | [[Digital rectal examination|DRE]]
[[Digital rectal examination|DRE]]
&
&
Serum [[PSA]]
Serum [[PSA]]
| style="background: #F5F5F5; padding: 5px;" |–
| align="left" style="background:#F5F5F5;" + |  
| style="background: #F5F5F5; padding: 5px;" |–
| style="background: #F5F5F5; padding: 5px;" |–
| style="background: #F5F5F5; padding: 5px;" |–
| style="background: #F5F5F5; padding: 5px;" | +  
| style="background: #F5F5F5; padding: 5px;" |–
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
* Sudden inability to [[urinate]]
* Sudden inability to [[urinate]]
* [[Urinary tract infection|Urinary tract infections]]
* [[Urinary tract infection|Urinary tract infections]]
* [[Urinary stone|Urinary stones]]
* [[Urinary stone|Urinary stones]]
* Damage to the [[Kidney|kidneys]]
* Damage to the [[Kidney|kidneys]]
* [[Hematuria|Blood in the urine]]
| align="left" style="background:#F5F5F5;" + |  
| style="background: #F5F5F5; padding: 5px;" |
* Involves mainly central or transitional zone  
* Involves mainly central or transitional zone  
* [[Hyperplasia]] rather than [[Organ hypertrophy|hypertrophy]]
* [[Hyperplasia]] rather than [[Organ hypertrophy|hypertrophy]]
Line 514: Line 544:
* [[Nocturia]]
* [[Nocturia]]
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Neoplasms  
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Neoplasms'''
| style="background: #F5F5F5; padding: 5px;" |
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | –
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | –
| align="center" style="background:#F5F5F5;" + | +/–
| align="center" style="background:#F5F5F5;" + | –
| align="center" style="background:#F5F5F5;" + | –
| align="center" style="background:#F5F5F5;" + | +
| align="left" style="background:#F5F5F5;" + |  
*[[Hematuria]] may be seen
*[[Hematuria]] may be seen
| style="background: #F5F5F5; padding: 5px;" |–
| align="center" style="background:#F5F5F5;" + | –
| style="background: #F5F5F5; padding: 5px;" |[[Imaging]] and [[biopsy]]
| align="center" style="background:#F5F5F5;" + | [[Imaging]] and [[biopsy]]
| style="background: #F5F5F5; padding: 5px; text-align:center" | +–
| align="left" style="background:#F5F5F5;" + |  
| style="background: #F5F5F5; padding: 5px;text-align:center" |–
| style="background: #F5F5F5; padding: 5px;text-align:center" |–
| style="background: #F5F5F5; padding: 5px;" | +  
| style="background: #F5F5F5; padding: 5px; text-align:center" | +
| style="background: #F5F5F5; padding: 5px;" |–
| style="background: #F5F5F5; padding: 5px; text-align:center" | +
| style="background: #F5F5F5; padding: 5px; text-align:center" | +
| style="background: #F5F5F5; padding: 5px;" |–
| style="background: #F5F5F5; padding: 5px;" |
* Sudden inability to [[urinate]]
* Sudden inability to [[urinate]]
* Recurrent [[Urinary tract infection|urinary tract infections]]
* Recurrent [[Urinary tract infection|urinary tract infections]]
* [[Weight loss]] and other constitutional symptoms
* [[Weight loss]] and other constitutional symptoms
| style="background: #F5F5F5; padding: 5px;" |
| align="left" style="background:#F5F5F5;" + |  
* [[Cachexia]]
* [[Cachexia]]
* Gradual progression
* Gradual progression
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="2" |<small>Diseases</small>
| colspan="5" |<small>'''Symptoms'''
! colspan="4" |<small>Physical Examination</small>
! colspan="3" |<small>Diagnostic tests</small>
! colspan="1" rowspan="2" |<small>Past medical history</small>
! rowspan="2" |<small>Other Findings</small>
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
!<small>Hematuria</small>
!<small>Pyuria</small>
!<small>Frequency</small>
!<small>Urgency</small>
!<small>Dysuria</small>
!<small>Fever</small>
!<small>Tenderness</small>
!<small>Discharge</small>
!<small>Inguinal Lymphadenopathy</small>
!<small>Urinalysis</small>
!<small>Urine Culture</small>
!<small>Gold Standard
|-
|}
|}
==Treatment==
* To view the treatment of urinary tract infection [[Urinary tract infection resident survival guide|click here]].
* To view the detailed treatment of [[asymptomatic bacteriuria]] [[Asymptomatic bacteriuria#treatment|click here]].
* To view the detailed treatment of [[cystitis]] [[Cystitis medical therapy|click here]].
* To view the detailed treatment of [[urethritis]] [[Urethritis medical therapy|click here]].
* To view the detailed treatment of [[prostatitis]] [[Prostatitis medical therapy|click here]].
* To view the detailed treatment of [[pyelonephritis]] [[Pyelonephritis medical therapy|click here]].


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
{{WH}}
 
{{WS}}
[[Category:Medicine]]
[[Category:Medicine]]
[[Category:Infectious disease]]
[[Category:Infectious disease]]
Line 546: Line 603:
[[Category:Urology]]
[[Category:Urology]]
[[Category:Up-To-Date]]
[[Category:Up-To-Date]]
[[Category:Primary care]]
[[Category:Emergency medicine]]

Latest revision as of 14:06, 19 October 2020

https://https://www.youtube.com/watch?v=IE_ywuQoJSg%7C350}}


Resident
Survival
Guide

For patient information click here

Urinary Tract Infection Microchapters

Patient Information

Overview

Classification

Pyelonephritis
Cystitis
Prostatitis
Urethritis
Asymptomatic bacteriuria

Causes

Differential Diagnosis

Treatment

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Usama Talib, BSc, MD [2]

Synonyms and keywords: UTI

Overview

A urinary tract infection is an infection that involves any part of the urinary tract. It can result due to the invasion by a bacteria, virus, fungus or any other pathogen. The most common cause of a urinary tract infection is a bacterial infection. Depending on the site of the infection, a urinary tract infection can be classified as either upper or lower UTI. Lower UTI includes urethritis, prostatitis, asymptomatic bacteriuria, and cystitis (bladder infection), where as upper UTI may include pyelonephritis (infection of the kidneys) and rarely urethritis (infection of the ureters). Each subtype of urinary tract infection can also be subclassified on the basis of duration, etiology or therapeutic approach as acute, chronic, or recurrent and as uncomplicated or complicated infections.

The urine is normally sterile, a urinary tract infection occurs when the normally sterile urinary tract is infected by bacteria, which leads to irritation and inflammation. Pyelonephritis and cystitis result mostly from ascending infections from the urethra (urethritis) but can also result from descending infections such as hematogenous spread, or by the lymphatic system. The condition more often affects women, but can affect either gender and all age groups. The pathogenesis of a complicated UTI may include obstruction and stasis of urine flow.[1] Various factors are associated with the risk of developing a urinary tract infection. A common cause of the urinary tract infection in hospital settings is the urinary catheter placement. Diabetes, Crohn's disease, iatrogenic causes, endometriosis, pelvic inflammatory disease, urinary obstruction, and bladder incontinence are some risk factors for acquiring a urinary tract infection. A thorough physical exam is very helpful in differentiating upper from lower urinary tract infections. Patients with an uncomplicated urinary tract infections are usually well–appearing. The symptoms may include abnormal urine color (cloudy), blood in the urine, frequent urination or urgent need to urinate, dysuria, pressure in the lower pelvis or back, suprapubic pain, flank pain, back pain, fever, nausea, vomiting, and chills.[2] Urinalysis and urine culture are very helpful laboratory tests in diagnosing a urinary tract infection. Pyuria and either white blood cells (WBCs) or red blood cells (RBCs) may be seen on urinalysis. Escherichia coli ("E. coli"), a bacterium found in the lower gastrointestinal tract is one of the most common culprits. The individual infection must be differentiated from various causes of dysuria such as cystitis, acute pyelonephritis, urethritis, prostatitis, vulvovaginitis, urethral strictures or diverticula, benign prostatic hyperplasia and neoplasms such as renal cell carcinoma and cancers of the bladder, prostate, and penis. Antimicrobial therapy is indicated in case of a symptomatic UTI.[3][4] A large proportion of patients with acute uncomplicated urinary infections will recover without treatment within a few days or weeks. If left untreated, some patients may progress to develop recurrent infection, involve and infect other parts of the urinary tract, hematuria, and rarely renal failure. Prognosis is generally good for lower UTIs.[5] The treatment of a UTI depends on the type of the disease, the disease course (acute uncomplicated versus complicated), history of the individual, and the rates of drug resistance in the community. Preventative measures to avoid a UTI include abstinence, being faithful, using a condom, using barrier contraception during sexual intercourse, urinating after intercourse, increasing fluid intake and frequency of urination, and use of estrogen among postmenopausal women.

Classification

Urinary tract infections can be classified as follows:

Anatomical Classification

 
 
 
 
 
 
 
 
 
 
 
 
Urinary tract infections
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Upper UTI
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Lower UTI
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Pyelonephritis
 
 
Cystitis
 
 
 
 
 
 
 
Prostatitis
 
 
 
Urethritis
 
 
 
 
 
Asymptomatic bacteriuria
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
• Acute uncomplicated
• Acute complicated
• Chronic
•Emphysematous
• Xantho-granulomatous
 
 
• Acute uncomplicated
• Complicated
•Recurrent/chronic
 
 
 
 
 
 
 
• Acute bacterial
• Chronic bacterial
• Chronic inflammatory
• Chronic non-inflammatory
•Asymptomatic
 
 
 
 
 
 
 
 
 

Classification Based on Symptoms

This classification is primarily used to estimate duration of antibiotic treatment.[6]

 
 
 
UTI
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Fever > 99.9 F OR
Flank pain or CVA tenderness with pyuria OR
Fever with pyuria OR
Sepsis OR
• Systemic signs such as chills, rigors, fatigue OR
• UTI in men OR
• Anatomical renal defects OR
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Present (anyone)
 
 
 
Absent
 
 
 
 
 
 
 
 
 
 
 
 
Treat as complicated UTI
• 5 - 14 days based on choice of antibiotics
 
 
 
Treat as uncomplicated UTI
• 5 days

Causes

The various causes of urinary tract infections include:

Common Pathogens Pyelonephritis Cystitis Urethritis Prostatitis Asymptomatic Bacteriuria
Ecoli*[7][8][9][10] + (70%) + (78.6%) + (58%) + (80%)
Klebsiella[11] + + + +
Proteus[12] + + + +
Neisseria gonorrhoeae[13] + (21.6%) +
Pseudomonas[14] + + + +
Staphylococcus + + + +
Chlamydia trachomatis[15][16][17] + + + (20–30%) +
Mycoplasma[18][19] + +
Trichomonas[20][21][22] + + + +

*Ecoli is the most common cause of all urinary tract infections[23]

Differential Diagnosis

Urinary tract infections should be differentiated from one another and from various other diseases:

Diseases Symptoms Physical Examination Diagnostic tests Past medical history Other Findings
Hematuria Pyuria Frequency Urgency Dysuria Fever Tenderness Discharge Inguinal Lymphadenopathy Urinalysis Urine Culture Gold Standard
Differentiating amongst different types of urinary tract infections:
Pyelonephritis + + + + Flank or costovertebral angle + + Identifies causative bacteria Urine culture
Cystitis + + + + + + Suprapubic + >100,000CFU/mL Urine culture
Urethritis + + + Urethral discharge + Gram stain & mucoid or purulent discharge
Prostatitis + + + + + Identifies causative bacteria (in bacterial subtypes) Urine culture
Diseases Symptoms Physical Examination Diagnostic tests Past medical history Other Findings
Hematuria Pyuria Frequency Urgency Dysuria Fever Tenderness Discharge Inguinal Lymphadenopathy Urinalysis Urine Culture Gold Standard
Differentiating UTIs from other diseases:
Vulvovagintis + + Vaginal discharge  + Gram stain & culture of discharge
  • Number and type of sexual partners (new, casual, or regular)
  • Prior STDs
  • Previous history of symptomatic BV in female partner (in homosexual women)
Cervicitis + + + Cervical Endocervical exudate Culture for gonococcal cervicitis
Epididymitis + + + + + Testicular & suprapubic +/– urethral discharge + + Culture
Syphilis

(STD)

+/– + Darkfield microscopy
BPH + + + + DRE

& Serum PSA

Neoplasms + + + +/– + Imaging and biopsy
Diseases Symptoms Physical Examination Diagnostic tests Past medical history Other Findings
Hematuria Pyuria Frequency Urgency Dysuria Fever Tenderness Discharge Inguinal Lymphadenopathy Urinalysis Urine Culture Gold Standard

Treatment

References

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