UTI: Diagnosis and Treatment

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.