UTI: Diagnosis and Treatment

by Amy Sussman, MD

My Notes
  • Required.
Save Cancel
    Learning Material 3
    • PDF
      Slides Urinary Tract Infections.pdf
    • PDF
      Reference List Nephrology.pdf
    • PDF
      Download Lecture Overview
    Report mistake

    00:01 So what are some of the clinical manifestations of UTI in our how to our patients present? With cystitis, patients will complain of irritate avoiding habits.

    00:10 That means they have burning with urination or dysuria, urgency, frequency to void, suprapubic pain, possible hematuria.

    00:19 When they have pyelonephritis remember that's UTI that involves the kidney and upper tracks that patient is going to present with fevers, chills, flank pain.

    00:28 They're going to have costovertebral angle tenderness on physical exam that might be associated with nausea, vomiting, and pain in the lower abdomen.

    00:36 They may not always have irritated voiding symptoms or symptoms of cystitis.

    00:41 There's some atypical presentations and complicated UTI that we should be aware of as well.

    00:46 Prostatitis in men typically presents with symptoms of cystitis, so dysuria urgency frequency to void, but oftentimes men will complain of pelvic pain as well.

    00:58 In the elderly, we need to worry about more generalized signs and symptoms of infection.

    01:03 So things like fevers, chills, or altered mental status.

    01:07 Maybe the way an elderly person will present.

    01:11 So based on our patients clinical presentation that suspect for UTI, we now are going to look for physical exam findings that can help us with diagnosis.

    01:19 Costovertebral angle tenderness or abdominal and suprapubic tenderness are going to be common in patients who have urinary tract infection.

    01:26 A digital rectal exam to evaluate for edematous prostate is going to be helpful for prostatitis and men with pelvic or pernil pain.

    01:34 Laboratories are also going to be helpful in the diagnosis of UTI.

    01:38 So looking at our urine analysis or urine dipstick, the presence of leukocyte esterase indicates white blood cells that are present in the urine.

    01:47 The present of nitrites then tells us that gram-negative bacteria such as the enterobacteriaceae are present as well.

    01:55 Now be careful because staph and enterococcus do not reduce nitrates to nitrite.

    02:00 So we may be missing that just on a urinary dipstick alone.

    02:04 Urine microscopy is also very important.

    02:07 We can actually see white blood cells called pyuria, which is an indicates in an inflammation or infection.

    02:15 Occasionally, If somebody has pyelonephritis or upper urinary tract infection, then we can see a white blood cell cast.

    02:23 Red blood cells or hematuria may be present with significant inflammation particularly of the bladder epithelium.

    02:29 And of course, we want to get that urine culture that will give us the definitive diagnosis with the etiologic agent.

    02:36 So growth of 10 to the 5th or more colony forming units per millimeter of a uropathogen would be positive.

    02:43 So once we've made the diagnosis of UTI in our patients, we want to start treatment.

    02:47 Now, there's a couple of different considerations and treatment.

    02:50 If our patients are healthy, they have a lower urinary tract infection.

    02:53 We can do outpatient treatment and that's going to consist of a three to seven day antibiotic regimen.

    02:58 For E. Coli and other common gram-negative bacteria.

    03:02 We can use antibiotics like trimethoprim sulfamethoxazole nitrofurantoin or fosfomycin.

    03:08 We do want to be cognizant of avoiding routine use of broader agents like fluoroquinolone.

    03:13 We certainly don't want to generate generate multi-drug resistant organisms.

    03:18 Staph saphrophyticus gets the same treatment as above with trimethoprim nitrofuratoin or fosfomycin.

    03:25 Enterococcus species, however, require different antibiotics with coverage for enterococcus and that's going to include amoxicillin or amoxicillin clavulanic acid.

    03:34 For complicated UTIs or patients who are going to be impatient for treatment.

    03:39 We want to 10 to 14 day antibiotic regimen.

    03:42 And at this point a urine culture with antimicrobial sensitivities is going to be critical in order to successfully treat that underlying urinary tract infection.

    About the Lecture

    The lecture UTI: Diagnosis and Treatment by Amy Sussman, MD is from the course Urinary Tract Infection (UTI).

    Included Quiz Questions

    1. Elderly patients may have nonspecific presentations without clear symptoms localizing to the urinary tract.
    2. Signs and symptoms of cystitis include fever, chills, and costovertebral angle tenderness.
    3. The dipstick nitrite test indicates the presence of white blood cells in the urine.
    4. The standard threshold for bacterial growth on a midstream urine specimen that is reflective of bladder bacteriuria is ≥ 1,000 colony-forming units (CFU)/mL.
    1. Trimethoprim/sulfamethoxazole
    2. Carbapenem
    3. Vancomycin
    4. Levofloxacin
    5. Daptomycin

    Author of lecture UTI: Diagnosis and Treatment

     Amy Sussman, MD

    Amy Sussman, MD

    Customer reviews

    5,0 of 5 stars
    5 Stars
    4 Stars
    3 Stars
    2 Stars
    1  Star