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Renal stones can also create an environment that promotes bacterial growthApproximately 80%–90% of uncomplicated UTIs in women are the result of E. coliCandidamay also be a causative agent in complicated UTI that fails to respond to antibiotic therapyLower UTI: Clinical PresentationMost frequently reported symptomsDysuria
Urinary frequency or urgencyNocturiaHematuriaLow back or suprapubic painUrinary incontinenceCloudy, foul-smelling urineClean-catch, midstream urine sample for urinalysisUrinalysis may exhibitCloudy appearanceAlkaline pHHematuriaElevated levels of nitritesLeukocyte esteraseUrine sediments of RBCs, WBCs, mucus, and bacterial overgrowthLower UTI: Diagnostic TestingUrinalysisSample showing more than 100,000 organisms/mL is indicative of infectionPLUS presence of characteristic clinical symptomsUrine culture is considered the gold standard for laboratory confirmation of UTIUrinalysis with microscopyUrine culture and sensitivityIC: potassium sensitivity test (PST)Lower UTI: Differential DiagnosisDifferential diagnosisTumorsUpper UTIVaginitisSTDsLower UTI does not exhibits signs of sepsis (fever, chills, WBC casts, CVAT)Lower UTI: ManagementPharmacological antimicrobial management is the mainstay of treatmentAmpicillin and sulfonamides are becoming increasingly resistantNitrofurantoin seems most effective on gram-negative and gram-positive cocci; 7-day regimenTrimethoprim-sulfamethoxazole is also effective; 3-day regimen for uncomplicated UTIThe fluoroquinolones have widespread efficacyDuring pregnancyEspecially important as an established link exists between premature delivery and UTIEmpirical therapy: amoxicillin, nitrofurantoin, or cephalexinMost treatment is 1 weekFluoroquinolones should be avoidedHistory of UTI: postcoital prophylaxisFungal UTI: fluconazole 200 mg qd 7–14 daysTreatment also indicated forPre-urological proceduresAfter removal of a bladder catheterAny patient with an underlying structural abnormalityChronic UTI: prophylactic treatment either on a daily basis or after sexual intercourseAntibiotics may also relieve pain and discomfortInterstitial cystitis (IC) does not respond to antibiotics
Lower UTI: Follow-up and ReferralMidstream, clean-catch urine sample for urinalysisIndwelling catheters should be changed every 4–6 weeks Maintain adequate hydration and monitor urine outputObstructions must be identified and removedPrescribe analgesics for patients to reduce pain associated with UTILower UTI: Patient EducationInstruct patient to notify clinician if flank pain, hematuria, or lack of response to treatment occursAdvise patient toComplete full course of antibiotic therapyIncrease fluid intake to eight 8-ounce glasses of H2O