4) A 78-year old female presents with an indwelling foley

catheter and pyuria.

a) What would you do for this patient at this time?

b) How might your work-up/management change if she was having fevers and
confusion?

Pyuria is a urinary condition that is characterized by an elevated number of white blood cells
in the urine. Pyuria can cause the urine to look cloudy or as if it contains pus.
In my opinion complicated cystitis
 E. coli most common cause
 Indwelling foley catheters is the risk factor

a) Change Catheter
Foley catheters generally require skilled care once approximately every 30 days
While wearing a Foley catheter, patient has a greater risk of getting a urinary tract infection
(UTI).
 Diagnosis:
 Urinalysis –Leukocytes on urinalysis

 Urine culture -

 Indwelling foley catheter

 Try to get rid of foley if possible!
 Only treat patient when symptomatic (fever, dysuria)
 Patient’s with indwelling catheters are frequently colonized with great
deal of bacteria.
 Should change foley before obtaining culture, if possible

 Candiduria:
 Frequently occurs in patients with indwelling foley.
 If grows in urine, try to get rid of foley!
 Treat only if symptomatic.
 If need to treat, give fluconazole (amphotericin if resistance)

 Treatment:
 Fluoroquinolone (or other broad spectrum antibiotic)
 7-14 days of treatment (depending on severity)
 May treat even longer (2-4 weeks) in males with UTI
5)58-year old man presents with his first episode of
urinary frequency and dysuria. Urinalysis shows pyuria
and bacilli
a) What type of UTI does this patient likely have?
b) How would you treat this man, and for how long?
c) What activities would put this patient at risk for UTI?

1)Complicated Cystitis

2) Treatment:
Fluoroquinolone (or other broad spectrum antibiotic)

7-14 days of treatment (depending on severity)

May treat even longer (2-4 weeks) in males with UTI

3) poor hygiene; sexual activity, which can

introduce bacteria into the urinary tract;
6) A 28-year old male had a sexual encounter with a
prostitute while on a business trip in Batumi 1 week ago.
After returning home, he noted a burning sensation on
urination and a yellow discharge in his underwear.
Microscopic examination of the discharge reveals 4+
leukocyte esterase, and the following gram stain.
Which of the following is the best course of action for this patient?
a) Give the patient a prescription for doxycycline, 100 mg po BID for 7 days
b) Give the patient two prescriptions for ofloxacin 300 mg po QDay for 7 days, one for
him, and one for his wife.
c) Administer ceftriaxone – 125 mg IV x 1 and Azithromycin – 1 g po x 1, draw blood
for a VDRL and HIV – antibody arrange for his wife to be examined and treated.
d) Administer a single dose of Ceftriaxone – 125 mg IV x 1, and ciprofloxacin – 500 mg
po x 1 draw blood for a VDRL and HIV-antibody, and arrange for his wife to be
examined and treated.
e) Administer a single dose of cefixime – 400 mg, draw blood for a VDRL and arrange
for his wife to be examined and treated.

The venereal disease research laboratory

(VDRL) test is designed to assess whether you
have syphilis, a sexually transmitted infection
(STI).
Discharge Diseases- types of sexually transmited
diseases
Gonorrhea
 Typically found on or in leukocytes
in urethral pus
 Transmitted primarily via intimate
sexual contact
 Increasing number of strains
resistant to antibiotics

N. gonorrhoeae is the etiologic agent- also

known as the gonococcus
Symptoms in the male
Urethritis, painful urination and a
yellowish discharge
Leukocyte esterase (LE) is an esterase (a type of
enzyme) produced by leukocytes (white blood
cells). A leukocyte esterase test (LE test) is
a urine test for the presence of white blood
cells and other abnormalities associated
with infection.
Leukocyte esterase is a screening test used to
detect a substance that suggests there are white
blood cells in the urine. This may mean you have
a urinary tract infection