2. Genitourinary Infections

How is an Uncomplicated UTI defined?

Invasion of a structurally and functionally normal urinary tract by a nonresident infectious organism.

What defines a Complicated UTI?

An infection associated with an underlying condition that increases the risk of infection or failing therapy.

List 5 common conditions that classify a UTI as 'Complicated'.

Poorly controlled diabetes, pregnancy, hospital-acquired infection, presence of indwelling catheters, renal transplantation or immunosuppression.

How are UTIs classified by anatomical location?

Lower UTI includes urethritis and cystitis; Upper UTI includes pyelonephritis and perinephric abscess.

What differentiates a UTI from asymptomatic bacterial colonization?

A UTI shows an inflammatory response and associated signs/symptoms from bacterial invasion.

What is the most common route of infection for bacterial UTIs?

The ascending route of fecal flora through the urethra into the bladder.

What is an essential step in the pathogenesis of UTI in women?

Colonization of the mucosa of the vaginal opening.

What is the most common causative organism for acute uncomplicated cystitis?

Escherichia coli (75–95% of cases).

Which organism is most common in sexually active adolescent females?

Staphylococcus saprophyticus.

Which organisms are often seen in Complicated UTIs but rarely in Uncomplicated UTIs?

Pseudomonas, Serratia, Providencia, enterococci, staphylococci, fungi.

What are the hallmark symptoms of Acute Uncomplicated Cystitis?

Painful or frequent urination, suprapubic discomfort, turbid urine, ± microscopic hematuria.

How might a UTI present in an older adult?

Confusion, lethargy, anorexia, and incontinence.

What physical exam findings are relevant for cystitis symptoms?

Lower abdominal tenderness, absence of CVA tenderness, pelvic exam.

What are the typical Urinalysis findings for cystitis?

Pyuria, Bacteriuria, positive Nitrites, +/- microscopic Hematuria.

If White Blood Cell (WBC) casts are found in the urine, what does this indicate?

An upper tract infection (Pyelonephritis).

When is a urine culture warranted in cystitis?

Persistent symptoms, recurrence within 3 months, atypical symptoms, suspected complicated infection.

When is CT scanning without contrast indicated?

Renal calculi, gas-forming infections, hemorrhage, obstruction, abscesses.

What are the first-line treatment options for uncomplicated cystitis in non-pregnant women?

Nitrofurantoin, Trimethoprim-sulfamethoxazole, Fosfomycin.

What are the second-line treatment options for uncomplicated cystitis?

Ciprofloxacin, Levofloxacin, Beta-lactams.

Which antibiotics should NOT be used empirically for cystitis?

Amoxicillin or Ampicillin.

How are 'recurrent' UTIs managed regarding prophylaxis?

Postcoital prophylaxis, long-term antimicrobial prophylaxis, vaginal estrogen cream.

What are the classic signs/symptoms of Acute Pyelonephritis?

Fever, flank pain, nausea, vomiting, tachycardia, plus cystitis symptoms.

What are the criteria for hospital admission for Pyelonephritis?

Inability to tolerate oral intake, unstable vital signs, pregnancy, suspected urinary obstruction.

What is the outpatient treatment regimen for Pyelonephritis?

Ciprofloxacin, Trimethoprim-sulfamethoxazole, Levofloxacin.

What is the recommended inpatient empiric treatment for Pyelonephritis?

Parenteral therapy with Ceftriaxone, Fluoroquinolone, Piperacillin-tazobactam.

If a patient with pyelonephritis has persistent symptoms after 3 days of appropriate antibiotics, what is the next step?

Evaluate by CT scan for obstruction or perinephric abscess.

How is Asymptomatic Bacteriuria defined in women?

Two consecutive clean-catch voided specimens with isolation of the same organism in a patient without symptoms.

How is Asymptomatic Bacteriuria defined in men?

A single clean-catch voided specimen with a single organism without symptoms.

Which populations require treatment for Asymptomatic Bacteriuria?

Pregnant women, patients undergoing urologic procedures.

Why must pregnant women be treated for asymptomatic bacteriuria?

To avoid developing pyelonephritis, which can lead to low birth weight and prematurity.

What is the first-line treatment for bacteriuria in pregnancy?

Nitrofurantoin 100 mg BID x 5–7 days.

What are the risk factors for UTI in men?

Older age, prostate disease, MSM, lack of circumcision, immunocompromised status.

What is the treatment duration for UTI in men?

7–14 days using Bactrim or Fluoroquinolones.

How is bacterial prostatitis treated?

Bactrim or Fluoroquinolones for 6 weeks.

Why are Nitrofurantoin and beta-lactams generally avoided for UTIs in men?

They do not achieve reliable tissue concentrations for treating occult prostatitis.

What defines an Uncomplicated UTI?

A normal urinary tract infected by a nonresident organism.

What is the role of anatomical classification in UTIs?

To differentiate between lower and upper UTIs based on the affected areas.

What is typically absent in a UTI compared to asymptomatic bacterial colonization?

An inflammatory response and associated symptoms.

What organism is most frequently responsible for uncomplicated cystitis in women?

Escherichia coli.

What role do indwelling catheters have in complicating UTIs?

They can lead to infections due to their presence in the urinary tract.

What are nitrites indicative of in a urinalysis?

The presence of Enterobacteriaceae in the urine.

What additional symptoms might older adults exhibit with a UTI?

Cognitive changes like confusion or lethargy.

What is CVA tenderness and its relevance?

Costovertebral angle tenderness, relevant for ruling out pyelonephritis.

What indicates the need for urine culture in a UTI case?

Persistent or recurrent symptoms after treatment.

What is the standard imaging method to check for pyelonephritis complications?

CT scan without contrast.

What is a typical medication choice for uncomplicated cystitis?

Nitrofurantoin.

What alternative medications are prescribed for persistent UTIs?

Ciprofloxacin or Levofloxacin.

Why is Amoxicillin not suitable for empiric UTI treatment?

Due to its variable efficacy against common UTI pathogens.

How does acute pyelonephritis differ from cystitis?

It typically presents with systemic symptoms like fever.

What happens if treatment fails after 3 days for pyelonephritis?

Imaging studies are warranted to check for complications.

What is essential for pregnancy-related UTI management?

Timely treatment to prevent escalation to pyelonephritis.

What is the impact of Bacteriuria on surgical procedures?

It requires treatment to prevent infection during procedures.

What is Nitrofurantoin's role in pregnancy-related UTIs?

Mainstay treatment during certain trimesters.

How does UTI risk vary among men?

Unique factors such as prostatic issues or sexual practices.

What is a standard duration of UTI treatment in males?

7 to 14 days depending on the antibiotic used.

What is preferred for bacterial prostatitis management?

Extended-course antibiotics typically including Bactrim.

Do Nitrofurantoin and beta-lactams effectively treat male UTIs?

No, they lack proper tissue penetration.

What is an alternative organism found in complicated UTIs?

Fungi.

How is urine evaluated for microscopic findings?

Using urinalysis to count leukocytes and look for bacteria.

What is a strong indicator of bladder infection in urinalysis?

Presence of pyuria in the urine sample.

What is the general correlation between diabetes and UTI?

Poorly controlled diabetes increases UTI risk.

What basic therapeutic principle applies to recurrent cystitis?

Both immediate and preventive treatment strategies are considered.

What can contribute to UTI recurrences postpartum?

Anatomical and hormonal changes affecting urinary tract dynamics.

What is an emergent scenario relating to acute pyelonephritis?

Rapid intervention for patients with comorbidities.

What conditions lead to upper tract infections?

Obstructions and anatomical abnormalities.

What comprehensive approach is taken for managing UTIs in men?

Consider evaluating for underlying prostate issues.

What happens when antibiotic treatment fails?

Possible need for reevaluation and alternative diagnostic testing.

How does pregnancy affect urinary tract dynamics?

Physiological changes during pregnancy increase infection risk.

What preventive measures exist for individuals with recurrent UTIs?

Lifestyle modifications and potential prophylactic antibiotics.

Significance of WBC casts in urinalysis?

Indicates upper urinary tract involvement, likely due to infection.

Impact of hydration on UTI prevention?

Increased fluid intake helps dilute urine and flush bacteria.

What needs to be addressed to prevent UTIs in postmenopausal women?

Estrogen levels affecting vaginal flora.

What lifestyle changes may decrease UTI risk?

Better hydration, good hygiene practices, and timely urination.

What are the possible complications of untreated UTIs?

Progression to pyelonephritis and potential systemic infection.

How do systemic symptoms differ in pyelonephritis vs. cystitis?

Systemic symptoms like high fever and chills primarily indicate pyelonephritis.

What preventive tips are useful for travelers regarding UTIs?

Maintain hydration and be cautious with hygiene in different locales.

What lifestyle adjustment may benefit recurrent UTI sufferers?

Regular voiding and avoiding irritative substances.

What is the clinical importance of differentiating between UTI types?

Help determine appropriate therapeutic strategies.

What are indications for follow-up in UTI management?

Persistent symptoms or recurrent infections post-treatment.

How is cystitis usually diagnosed?

Based on reported symptoms combined with urinalysis findings.

What factors affect appropriate antibiotic choices for UTIs?

Local resistance patterns and patient-specific considerations.

How does the anatomy of the urinary tract influence infection risk?

Structural abnormalities can provide routes for infection.

What is the principle prevention focus in UTI management?

Reducing risk factors and maintaining urinary tract health.

How can asymptomatic bacteriuria be misinterpreted?

Not all bacteria detected indicate an active infection.

What factors correlate with increased UTI prevalence in women?

Anatomical proximity of the urethra to the vagina and anus.

What type of test confirms a UTI diagnosis?

A combination of clinical symptoms and positive urinalysis results.

What is the primary treatment goal for UTIs?

To alleviate symptoms and eradicate the infectious organism.

What does the presence of nitrates in urine suggest?

The potential presence of bacteria typically causing UTIs.

What education should be provided regarding antibiotic use?

Finish the course as prescribed to prevent resistance.

How do hormonal changes contribute to UTI risk?

Altered vaginal flora can lead to increased susceptibility to infections.

What defines the difference between pyelonephritis and cystitis?

Pyelonephritis affects the kidneys; cystitis affects the bladder.

What is a common bladder irritant that can exacerbate UTI symptoms?

Caffeinated beverages, alcohol, and spicy foods.

Why is patient history valuable in UTI management?

To identify risk factors and guide treatment decisions.

What microbial resistance is concerning in UTI management?

Resistance seen with E. coli and other common uropathogens.

How can behavioral changes help in managing recurrent UTIs?

Changes like increased fluid intake and proper hygiene can reduce frequency.

What common misconception affects young women regarding UTIs?

That they can’t occur in those who are sexually active.

What correlation exists between hygiene practices and UTI rates?

Poor hygiene increases UTI occurrence, especially in females.

Why are follow-up appointments crucial after UTI treatment?

To ensure resolution and prevent chronic issues.

What should be considered regarding sexual practices and UTIs?

Certain practices can predispose individuals to UTIs.

How is a UTI diagnosed definitively?

Through urinalysis showing characteristic changes.