0071643192.pdf

RENAL AND GENITOURINARY

EMERGENCIES

A healthy 70-year-old female presents with 4 days of dysuria and urgency.

On clinical examination there is no evidence for pyelonephritis. UA shows

many WBCs and bacteria, + leukocyte esterase, + nitrite, and few RBCs

and epithelial cells. Is this patient a candidate for a 3-day course of antibiotic

therapy?

No. She needs a 7-day regimen. A 7-day regimen is recommended for preg-

nant women or those with >7 days of symptoms, comorbid conditions such as

diabetes, previous or recurrent UTI, or >65 years old.

URINARY TRACT INFECTION/PYELONEPHRITIS (ADULTS)

Urinary tract infection (UTI) is an infection of the urinary tract. With the
exception of the neonatal period, UTIs are more common in females than
males.

DEFINITIONS

Cystitis:Inflammation of the bladder; may be bacterial or nonbacterial

Complicated UTI:UTI associated with underlying disease that may put the
patient at risk for a broader spectrum of pathogens or an increased rate of fail-
ure of short course antibiotic therapy (see Table 18.7)

Pyelonephritis:Infection of the renal parenchyma and collecting system

ETIOLOGY

■ Organisms causing UTIs usually ascend the urethra from the perineum.
■ E. coliis the dominant pathogen, followed by Staphylococcus saprophyticus.
Less common organisms include Proteus,Klebseilla,andEnterobacter.
■ Patients at risk for unusual organisms include institutionalized or hospitalized
patients and complicated UTIs.

TABLE 18.7. Complicated UTIs

Men

Elderly

Pregnant women

Serious medical disease

Immunosuppression

Recent hospitalization

Treatment failure

Structural urinary tract abnormalities

Pyelonephritis

Indwelling catheter

Recent instrumentation