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so what are some of the clinical
manifestations of uti in our
how do our patients present with
cystitis
patients will complain of irritative
weighting habits that means they have
burning with urination or dyseria
urgency frequency to void suprapubic
pain
possible hematuria when they have
pyelonephritis remember that's uti that
involves the kidney and upper tracts
that patient is going to present with
fevers chills flank pain
they're going to have costovertebral
ankle tenderness on physical exam
that might be associated with nausea
vomiting and pain in the lower abdomen
they may not always have irritative
weighting symptoms or symptoms of
cystitis
there are some atypical presentations
and complicated uti that we should be
aware of as well
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
in the elderly we need to worry about
more generalized
signs and symptoms of infection so
things like fevers
chills or altered mental status may be
the way an elderly person will present
so based on our patient's clinical
presentation that suspect for uti
we now are going to look for physical
exam findings that can help us with
diagnosis
costo vertebral angle tenderness or
abdominal and suprapubic tenderness
are going to be common in patients who
have urinary tract infection
a digital rectal exam to evaluate for
edematous prostate is going to be
helpful for prostatitis in men with
pelvic or perineal pain
laboratories are also going to be
helpful in the diagnosis of uti
so looking at our urine analysis or our
urine dipstick the presence of leukocyte
esterase
indicates white blood cells that are
present in the urine
the presence of nitrites then tells us
that gram-native bacteria such as the
enterobacteracia
are present as well now be careful
because staph and enterococcus do not
reduce nitrates to nitrite
so we may be missing that just on a
urinary dipstick alone
urine microscopy is also very important
we can actually see
white blood cells called pyuria which is
indicates an
inflammation or infection occasionally
if somebody has pyelonephritis or upper
urinary tract infection
then we can see a white blood cell cast
red blood cells or hematuria may be
present with significant inflammation
particularly of the bladder epithelium
and of course we want to get that urine
culture that will give us the definitive
diagnosis with the ideologic agent
so growth of 10 to the fifth or more
colony forming units per
millimeter of a uropathogen would be
positive
so once we've made the diagnosis of uti
in our patients we want to start
treatment
now there's a couple of different
considerations in treatment if our
patients are healthy they have a lower
urinary tract infection we can do
outpatient treatment
and that's going to consist of a three
to seven day antibiotic regimen
for e coli and other common
gram-negative bacteria
we can use antibiotics like trimethoprim
sulfamethoxazole
nitrofurantoen or phosphomycin
we do want to be cognizant of avoiding
routine use of broader agents like
fluoroquinolones
we certainly don't want to generate
generate multi-drug resistant organisms
staph saprophyticis gets the same
treatment as above with trimethoprim
nitrofurantone or phosphomycin
enterococcal species however require
different antibiotics with coverage for
enterococcus and that's going to include
amoxicillin or amoxicillin clavulanic
acid
for complicated utis or patients who are
going to be impatient for treatment
we want a 10 to 14 day antibiotic
regimen
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
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so
you