Renal stones can also create an environment that promotes bacterial growth

Renal stones can also create an environment that

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Renal stones can also create an environment that promotes bacterial growth Approximately 80%–90% of uncomplicated UTIs in women are the result of E. coli Candida may also be a causative agent in complicated UTI that fails to respond to antibiotic therapy Lower UTI: Clinical Presentation Most frequently reported symptoms Dysuria
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Urinary frequency or urgency Nocturia Hematuria Low back or suprapubic pain Urinary incontinence Cloudy, foul-smelling urine Clean-catch, midstream urine sample for urinalysis Urinalysis may exhibit Cloudy appearance Alkaline pH Hematuria Elevated levels of nitrites Leukocyte esterase Urine sediments of RBCs, WBCs, mucus, and bacterial overgrowth Lower UTI: Diagnostic Testing Urinalysis Sample showing more than 100,000 organisms/mL is indicative of infection PLUS presence of characteristic clinical symptoms Urine culture is considered the gold standard for laboratory confirmation of UTI Urinalysis with microscopy Urine culture and sensitivity IC: potassium sensitivity test (PST) Lower UTI: Differential Diagnosis Differential diagnosis Tumors Upper UTI Vaginitis STDs Lower UTI does not exhibits signs of sepsis (fever, chills, WBC casts, CVAT) Lower UTI: Management Pharmacological antimicrobial management is the mainstay of treatment Ampicillin and sulfonamides are becoming increasingly resistant Nitrofurantoin seems most effective on gram-negative and gram-positive cocci; 7-day regimen Trimethoprim-sulfamethoxazole is also effective; 3-day regimen for uncomplicated UTI The fluoroquinolones have widespread efficacy During pregnancy Especially important as an established link exists between premature delivery and UTI Empirical therapy: amoxicillin, nitrofurantoin, or cephalexin Most treatment is 1 week Fluoroquinolones should be avoided History of UTI: postcoital prophylaxis Fungal UTI: fluconazole 200 mg qd 7–14 days Treatment also indicated for Pre-urological procedures After removal of a bladder catheter Any patient with an underlying structural abnormality Chronic UTI: prophylactic treatment either on a daily basis or after sexual intercourse Antibiotics may also relieve pain and discomfort Interstitial cystitis (IC) does not respond to antibiotics
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Lower UTI: Follow-up and Referral Midstream, clean-catch urine sample for urinalysis Indwelling catheters should be changed every 4–6 weeks Maintain adequate hydration and monitor urine output Obstructions must be identified and removed Prescribe analgesics for patients to reduce pain associated with UTI Lower UTI: Patient Education Instruct patient to notify clinician if flank pain, hematuria, or lack of response to treatment occurs Advise patient to Complete full course of antibiotic therapy Increase fluid intake to eight 8-ounce glasses of H 2 O
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