Professional Documents
Culture Documents
Infection
29-year-old Woman with History of Burning with Test case
Urination
A 29-year-old woman comes to the clinic complaining of a
3-day history of burning with urination and increased urinary
frequency. She has suprapubic discomfort but no new vaginal
discharge. She is in a monogamous relationship with her husband
and has been sexually active with her last sexual encounter 3 days
ago. Her last menstrual period was 1 week prior.
Cystitis Pyelonephritis
5. Asymptomatic bacteriuria
Pathogenesis of UTI: Uncomplicated
Infection
Urethra Anus
Pathogenesis of UTI: Uncomplicated
Infection
Host determinants:
• Same risk factors and host determinants from uncomplicated UTI play a role in
complicated UTI
Emphysematous Xanthogranulomatous
Renal abscess
pyelonephritis pyelonephritis
29-year-old Woman with History of Burning with Test case
Urination
A 29-year-old woman comes to the clinic complaining of a Cystitis
3-day history of burning with urination and increased urinary
frequency. She has suprapubic discomfort but no new vaginal
discharge. She is in a monogamous relationship with her
husband and has been sexually active with her last sexual Urinary tract infection (UTI)
encounter 3 days ago.
Labs:
Urine analysis: specific gravity 1.020, trace blood, leukocyte Infection due to gram
esterase positive, nitrite positive negative organisms (most
commonly, E. coli)
29-year-old Woman with History of Burning with Test case
Urination
What microbial agent most likely caused her
cystitis?
Escherichia
coli
Pyelonephritis
Physical exam
Urine microscopy
Urine culture
• Definitive diagnosis
• Enterococcus species
• Amoxicillin, amoxicillin-clavulanic
acid
Urinary Tract
Infection
Special populations
Urinary Infection in Children
♂ ♀ < ♂ ♀
In first year of life After first year of life
• More common in boys than girls • More frequent in girls than boys
• Associated with congenital • Most present as acute cystitis
anomalies of the urinary tract
• Obtained in first episode of pyelonephritis, UTI in boy or girl < 3 years, or recurrent
infections in girls > 3 years
Treatment:
Empiric treatment:
• Outpatient standard therapy
Behavioral treatment:
• Avoid spermicides
• Continuous prophylaxis
• Intermittent self-treatment
• Postcoital prophylaxis
45-year-old Woman in ER with Acute Onset of Test case
Fever
A 45-year-old woman is brought to the Emergency Department by
her husband for acute onset of fever and shaking chills/rigors. She
has had nausea, emesis, and has not been able to eat or drink without
vomiting. She notes right flank pain and describes some vague
abdominal discomfort. She believes she may have had some
increased frequency and urgency to void the day prior. Her last
menstrual period was 2 weeks prior.
Exam: Ill-appearing, temperature elevated to 39.1°C (102.4°F),
blood pressure is 98/68 mm HG, pulse 101/min, respiratory rate
28/min, right CVA tenderness to percussion, remainder of exam is
What is the most likely
normal
diagnosis in this patient?
Labs: White count elevated 18 x 109 with increased neutrophils on
differential. Urine analysis: Trace blood, leukocyte esterase
positive, nitrite positive, > 40 WBC/HPF, bacteria present
Urine and blood cultures are pending.
45-year-old Woman in ER with Acute Onset of Test case
Fever
A 45-year-old woman is brought to the Emergency Department
Indication of inpatient
by her husband for acute onset of fever and shaking treatment
chills/rigors. She has had nausea, emesis, and has not been
able to eat or drink without vomiting. She notes right flank pain
and describes some vague abdominal discomfort. She believes she
may have had some increased frequency and urgency to void the
day prior. Her last menstrual period was 2 weeks prior.
SIRS/sepsis and requires
Exam: Ill-appearing, temperature elevated to 39.1°C
inpatient admission
blood pressure is 98/68 mm HG, pulse 101/min, (102.4°F),
respiratory rate
28/min, right CVA tenderness to percussion, remainder of
exam is normal
Acute pyelonephritis
Emphysematous
Catheter associated
pyelonephritis
Xanthogranulomatous pyelonephritis
Complicated UTI – Acute
Pyelonephritis
Symptoms Diagnosis/treatment
• Fever (> 38°C), chills, flank/ • Urine analysis, urine culture and
abdominal pain, nausea, and sensitivity
emesis, +/- cystitis symptoms
• Presentations vary from mild to
sepsis with renal failure
Complicated UTI – Acute
Pyelonephritis
Treatment
Pathogenesis
• Prostate is edematous/tender
• Outpatient treatment
• Oral fluoroquinolones
Diagnosis:
• CT demonstrates gas
no changes
Complicated UTI – Emphysematous
Pyelonephritis
Treatment:
• Percutaneous drainage
• Nephrectomy
Complicated UTI – Xanthogranulomatous
Pyelonephritis
Symptoms
Diagnosis:
• Low-density masses
(xanthomatous tissue)
Complicated UTI – Xanthogranulomatous
Pyelonephritis
Microorganisms Treatment
What if the patient was pregnant? Would the patient need to be treated with
antibiotics?
Yes – this is one of the exceptions and indications to treat asymptomatic bacteriuria.
Asymptomatic Bacteriuria
Definition
• Isolation of a specified quantitative count of a single bacteria (> 105 CFU/mL) appropriately
collected from a urine sample in an individual without symptoms or signs of a UTI
Epidemiology
Treatment