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UTIs

UTIs. Goals Understand the diagnostic accuracy of history, physical and lab findings. Know appropriate management of uncomplicated vs. complicated UTIs . UTIs. Very common – 50% of women will have at least 1 UTI Definitions Lower UTIs – urethritis and cystitis

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UTIs

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  1. UTIs Goals Understand the diagnostic accuracy of history, physical and lab findings. Know appropriate management of uncomplicated vs. complicated UTIs.

  2. UTIs • Very common – 50% of women will have at least 1 UTI • Definitions • Lower UTIs – urethritis and cystitis • Upper UTIs – pyelonephritis and peri-nephric abscess • Upper UTIs are more likely if fever, flank pain, CVAT, nausea or vomiting

  3. Diagnosis • Women are fairly accurate in self-diagnosing UTIs • 50% of women presenting with UTI symptoms as a chief complaint will have a culture-proven UTI

  4. Differential Diagnosis • Vaginitis –gardnerella, candida, trichomonas • Cervicitis – chlamydia, gonorrhea • HSV

  5. General History • Historical features indicating a greater risk of UTI • Previous history of UTI • Recent sexual activity

  6. Diagnosis • Presence of dysuria and frequency and absence of vaginal discharge and vaginal irritation = very high likelihood of UTI

  7. Diagnosis Physical exam findings are less accurate

  8. Cases • 24 yo healthy female c/o dysuria and frequency • 2 prior UTIs • Currently sexually active in a monogamous relationship and using condoms • Denies vaginal symptoms Pre-test probability = 50% Likelihood ratio = 24.6 Post-test probability = 96%

  9. Cases • 20 yo healthy female c/o dysuria and frequency • Also c/o vaginal discharge and irritation • Sexually active in a monogamous relationship with intermittent condom usage • Dipstick u/a is normal Pre-test probability = 50% Likelihood ratios = 1.5, 1.8, 0.3, 0.2 Post-test probability = 20%

  10. Complicated vs. Uncomplicated • Uncomplicated – healthy female • Complicated – any male, any functional or anatomic abnormality • Diabetes • Immunosuppression • Pregnancy • Indwelling catheter • Neurogenic bladder • Recent urinary tract instrumentation • Polycystic renal disease • Nephrolithiasis

  11. Treatment • Uncomplicated • 80% E. Coli • Treat with tmp/smx, nitrofurantoin, or ciprofloxacin depending on local resistance pattern • Duration – 3 days (5 days nitrofurantoin) • Complicated • Broader range of organisms (proteus, klebsiella, pseudomonas, serratia, enterococci) • Organisms more likely to be resistant • Usually treat with quinolone (ciprofloxacin 500 mg bid or levofloxacin 500 mg or 750 mg daily) • Duration – 7 to 14 days

  12. Summary • Combination of dysuria and urinary frequency in the absence of vaginal symptoms has high likelihood of UTI • Uncomplicated UTIs are managed differently than complicated UTIs

  13. Reference • Bent et al. Does this woman have an acute uncomplicated urinary tract infection? JAMA 2002;287:2701-20.

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