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

Urinary catheters introduce bacteria directly into

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Urinary catheters introduce bacteria directly into urinary tract Spermicides and diaphragms promote urethral & vaginal colonization Female urethral massage and sexual activity allow bacteria to reach bladder
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Pathogenesis: Ascending Route Risk factors Vesicourethral reflux Normally urine flows from the bladder to the bladder via the ureters Retrograde flow of urine from the bladder to the kidneys Promotes development of pyelonephritis
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Pathogenesis: Ascending Route Risk factors Incomplete bladder voiding Disrupts flushing of bacteria from urinary tract Examples: benign prostate hypertrophy, tumor, neurogenic bladder
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Risk Factors Age Females Males <1 Abnormal anatomy or function Abnormal anatomy or function 1-5 Congenital abnormality Congenital abnormality 6-15 Vesicoureteral reflux None 16-35 Sexual activity Homosexuality 35-65 Ob-gyn surgery Prostate hypertrophy >65 Incontinence, chronic foley Incontinence, chronic foley Urologic surgery or manipulation Urinary tract obstruction (e.g. kidney stone) Urethral catheter Mandell: Prin and Practice Infect Dis
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Pathogenesis: Hematogenous Route Infection at alternate site Bacteria enters bloodstream and infects kidney Predictors of infection: microorganism and inoculum size Uncommon (<5%) Most common organism S. aureus
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Pathogenesis: Lymphatic Route Limited evidence to demonstrate significant role of renal lymphatics in the pathogenesis of upper urinary tract infections
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Diagnosis Diagnosis based on: Signs and symptoms Positive laboratory tests Positive cultures (i.e. microbiology)
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Clinical Presentation Asymptomatic bacteriuria Lower urinary tract infection (cystitis) Frequency, urgency, dysuria Urine may be cloudy or bloody Supra-pubic pain Fever usually absent
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Clinical Presentation Upper urinary tract infection (pyelonephritis) Similar to lower UTI Flank pain, fever, chills, nausea, vomiting, malaise Costovertebral angle (CVA) tenderness Bacteremia or urosepsis Children and elderly may present atypically Altered mental status GI complaints
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Laboratory Tests: Urinalysis Urinalysis (UA) Method of urine collection important Midstream clean catch Catheterization
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