Urinary Tract Infections (UTI) -- Student (2)

Suprapubic aspiration macroscopic analysis color

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Suprapubic aspiration Macroscopic analysis Color, specific gravity, pH, glucose, protein, ketones, blood, bilirubin, leukocyte esterase Microscopic analysis Bacteria, leukocytes, erythrocytes, epithelial cells, crystals, casts, nitrites
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Laboratory Tests: Urinalysis Bacteria Qualitative amounts reported in UA None, rare, few, many Quantitative amounts reported by urine culture Bacteriuria: ≥ 100,000 (10 5 ) CFU bacteria/mL of urine As low as 100-1,000 bacteria/mL may be used in diagnosis in symptomatic patients Nitrite Presence of nitrite indicates presence of bacteria capable of reducing nitrate ( E. coli ) Not all bacteria reduce nitrate (Gram-positive organisms or Pseudomonas ) Wilson ML et al. CID 2004;38:1150-58
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Laboratory Tests: Urinalysis White blood cells (WBC) Pyuria: More than 10 WBC/mm 3 of urine Indicates inflammation, not necessarily infection Leukocyte esterase (LE) Rapid test to detect pyuria Useful in outpatient setting Does not require microscope Does not rule out infection in symptomatic patients Wilson ML et al. CID 2004;38:1150-58
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Microbiology Urine culture necessary to identify causative organism 95% of UTIs are caused by single organism Community-associated UTIs E. coli most common (53-72%) Other : Staphylococcus saprophyticus , Proteus mirablis , Klebsiella spp Wilson ML et al. CID 2004;38:1150-58 Mandell: Prin and Practice Infect Dis 6 th ed
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Microbiology Healthcare-associated UTI E. coli most common Proteus , Klebisella , Pseudomonas , Enterobacter , and Enterococcus spp more common More likely to be drug-resistant Yeast ( Candida ) UTIs may occur in patients who have indwelling catheters and received antibiotics Wilson ML et al. CID 2004;38:1150-58 Mandell: Prin and Practice Infect Dis 6 th ed
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Classification of UTIs Uncomplicated UTI UTI in an otherwise healthy female Absence of structural or functional abnormalities of urinary tract Complicated UTI Presence of structural or functional abnormalities of urinary tract Presence of urinary catheter Male Pregnant women Hospitalized patients Implications Resistance Duration of antibiotic therapy
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Classification of Recurrent UTIs Reinfection Infections are caused by a different organism than originally isolated Majority of recurrent UTIs Relapse Repeated infections with the same initial organism Indicates a persistent infectious source
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