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LEARNING OBJECTIVES

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LEARNING OBJECTIVES

Upon completion of the chapter, the reader will be able to:

  1. Determine the diagnostic criteria for significant bacteriuria.

  2. Interpret the signs and symptoms of urinary tract infections (UTIs) and differentiate those of upper versus lower urinary tract disease.

  3. Identify the organism responsible for the majority of uncomplicated UTIs.

  4. Assess the laboratory tests that help in diagnosing patients with UTI.

  5. Recommend appropriate drug, dose, and duration for uncomplicated and complicated UTI prophylaxis and empiric treatment.

  6. Evaluate and select therapy for uncomplicated and complicated UTIs based on specific urine culture results and patient characteristics.

  7. Formulate appropriate monitoring and education information for patients with UTIs.

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KEY CONCEPTS

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  • Image not available. Urinary tract infections (UTIs) are thought of as either uncomplicated or complicated. Generally this refers to absence or presence, respectively, of functional or structural abnormalities within the urinary tract.

  • Image not available. The majority of uncomplicated UTIs are the result of a single causative organism, which is primarily Escherichia coli in up to 85% of cases. The remaining 15% are caused by Staphylococcus saprophyticus along with Klebsiella species (spp.), Proteus spp., Pseudomonas spp., Enterobacter spp., and Enterococcus spp.

  • Image not available. Symptoms of lower UTIs include dysuria, gross hematuria, suprapubic heaviness, nocturia, increased urinary frequency, and urgency.

  • Image not available. Symptoms of upper UTIs include fever, nausea, vomiting, malaise, and often severe flank pain.

  • Image not available. The goals of treatment are to eradicate the causative pathogen, to prevent or treat consequences of infection, and to prevent, if possible, recurrence of infection.

  • Image not available. Uncomplicated UTIs may be managed with a short course antimicrobial therapy with one-dose, 3-day, or 5-day regimens, depending on the clinical factors.

  • Image not available. Complicated UTIs including acute pyelonephritis should be treated for at least 7 days and sometimes 2 weeks or longer.

  • Image not available. Treatment of catheterized patients with bacteriuria should follow one of two treatment algorithms: (a) for asymptomatic patients, hold antibiotics and remove the catheter if possible; or (b) for symptomatic patients, initiate antibiotic therapy and remove the catheter if possible.

  • Image not available. Any urinary tract infection in a male is considered complicated and should be treated with at least 2 weeks of targeted antimicrobial therapy. Male patients with prostatic sources or prior treatment failure should be treated for up to 6 weeks.

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Urinary tract infections (UTIs) are comprised of a diverse array of syndromes depending on the location of the infection within the urinary tract.1,2, and 3 UTIs occur frequently and are responsible for approximately 5.3 million annual visits to primary care and surgical specialty offices along with approximately 2.6 million annual visits to hospital outpatient and emergency departments.4,5 In simplest of terms, a UTI is defined by microorganism(s) in the urinary tract, which does not represent contamination.

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Bacteriuria, or bacteria in the urine, does not always represent infection. For this reason a number of quantitative diagnostic criteria have been created (Table 79–1) to identify the amount of bacteria in the urine that ...

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