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| ==Background== | | ==Background== |
| *Also known as acute cystitis; abbreviation = UTI
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| ===Definitions=== | | ===Definitions=== |
| *UTI = significant bacteriuria in presence of symptoms | | *UTI = significant bacteriuria in presence of symptoms |
| **Described by location: urethritis, cystitis, or pyelonephritis | | **Described by location: urethritis, cystitis, or pyelonephritis |
| *Relapse
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| **Recurrence of symptoms w/in month despite tx
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| ***Caused by same organism and represents treatment failure
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| *Reinfection
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| **Development of symptoms 1-6mo after tx
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| **Usually due to a different organism
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| **If pt has >3 recurrences in 1 yr consider tumor, calculi, [[diabetes]]
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| *Men <50 yr: symptoms of dysuria or urinary frequency usually due to [[STI]]
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| *Men >50 yr: incidence of UTI rises dramatically d/t prostatic obstruction
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| *Uncomplicated UTI:
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| **No structural or functional abnormalities w/in urinary tract or kidney
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| **No relevant comorbidities that place pt at risk for more serious adverse outcome
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| **Not associated with GU tract instrumentation
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| ===Risk factors for complicated UTI===
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| #Male sex
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| ##In young males dysuria is more commonly d/t STI
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| ##Suspect underlying anatomic abnormality in men with culture-proven UTI
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| #Anatomic abnormality of urinary tract or external drainage system
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| ##Indwelling urinary catheter, stent
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| ##Nephrolithiasis, neurogenic bladder, polycystic renal disease, recent instrumentation
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| #Recurrent UTI (three or more per year)
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| #Advanced age in men (BPH, recent instrumentation, recent prostatic biopsy)
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| #Nursing home residency (w/ or w/o indwelling bladder catheter)
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| #Neonatal state
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| #Comorbidities ([[DM]], sickle cell disease)
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| #Pregnancy
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| #Immunosuppression ([[AIDS]], immunosuppressive drugs)
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| #Advanced neurologic disease ([[CVA]] w/ disability, [[Spinal Cord Injuries]])
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| #Known or suspected atypical pathogens (Non–E. coli infection)
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| #Known or suspected abx resistance (resistance to Cipro predicts multidrug resistance)
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| ===[[Microbiology]]===
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| *Most common pathogen is [[E. coli]]
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| *[[Anaerobic]] organisms are rarely pathogenic (do not grow well in urine)
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| *Complicated UTIs more likely to be caused by [[pseudomonas]] or [[enterococcus]]
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