Acute complicated UTI in adults
Cistitis/pyelonephritis
Pathogenesis: colonization of vaginal introitus or urethral meathus or bacteremia (pyelo)
Complicated: extended beyond bladder (fever, pyelo, sepsis, bactermia)
Terminology Diagnostic approach
Acute complicated UTI: evaluation
e
Fever >37.7ºC ACUTI: dysuria, freq/urg, suprapubic
Signs of systemic illnes (chills, pain AND ALSO fever, chills, flank pain,
fatigue) etc OR nonlocalizing fever or sepsis
Flank pain Acute pyelo: fever, flank pain EVEN in
Costovertebral angle tenderness Careful: might
ABSENCE of other symp.
Pelvin or perineal pain in men T suggest
acompannying Women: pelvic inflammatory disease
prostatitis
Men: acute prostatitis
Pyelo: complicated UTI regardless of Elder: debilitated, unspecific
symp symptoms, change in funcional
Acute simple cystitis: absence of symp status, altered mind state
Considerations Labs
Both urinalysis
Urologic abnormalities, men, Pyuria and bacteriuria may ocasionally
inmunocompromising conditions or be absent (eg: obstruction of collecting
poorly controlled DM. Not considered system)
CUTI if no concerning symp of upper Imaging
tract or systemic infection Persistent symptoms after 2-3d on
ATB
Micro 6% are BLEE
Low renal function: sugest
^ obstruction
E Coli BIE ET in hospital ized px
p Recurrent
Enterobacteriae: Klebsiella, Proteus
Sepsis/shock: find abscess
Psuedomonas Common in pxw/ healthcare
→
Enterococci ex POSSUM
PYEIO : hypodenselesions
→ CT scan: study of choice.
SAMS/SAMR dueto ischemia by
neutro philic infiltra tion & may be normal in mild infection
Strep B edema
Candida
Diagnosis (ACUTI)
Symptoms of cystitis + pyuria/bacteriu
?1o
Clinic Asymp bact
:
Flank pain/tenderness + pyuria/bacter
Cystitis: dysuria, urinary freq/urg, Fever or sepsis without localizing
W or W /o
suprapubic pain, hematuria pyuria symptoms + pyuria and bacteriuria
Pyelo: fever, chills, flank pain,
costovertebral tenderness, vomits. Management
Atypical pain in epigastrium or LA Indications for hospitalization
Septic or critically ill
Complications Persistent >38.4ºC
Sepsis, bacteremia, shock, acute Pain
Marked debility or dehydration
renal failure (obstruction, recent qx,
Concerns with adherence
DM). Abscess, papillary necrosis
Suspected obstruction
Cistitis/pyelonephritis
Pathogenesis: colonization of vaginal introitus or urethral meathus or bacteremia (pyelo)
Complicated: extended beyond bladder (fever, pyelo, sepsis, bactermia)
Terminology Diagnostic approach
Acute complicated UTI: evaluation
e
Fever >37.7ºC ACUTI: dysuria, freq/urg, suprapubic
Signs of systemic illnes (chills, pain AND ALSO fever, chills, flank pain,
fatigue) etc OR nonlocalizing fever or sepsis
Flank pain Acute pyelo: fever, flank pain EVEN in
Costovertebral angle tenderness Careful: might
ABSENCE of other symp.
Pelvin or perineal pain in men T suggest
acompannying Women: pelvic inflammatory disease
prostatitis
Men: acute prostatitis
Pyelo: complicated UTI regardless of Elder: debilitated, unspecific
symp symptoms, change in funcional
Acute simple cystitis: absence of symp status, altered mind state
Considerations Labs
Both urinalysis
Urologic abnormalities, men, Pyuria and bacteriuria may ocasionally
inmunocompromising conditions or be absent (eg: obstruction of collecting
poorly controlled DM. Not considered system)
CUTI if no concerning symp of upper Imaging
tract or systemic infection Persistent symptoms after 2-3d on
ATB
Micro 6% are BLEE
Low renal function: sugest
^ obstruction
E Coli BIE ET in hospital ized px
p Recurrent
Enterobacteriae: Klebsiella, Proteus
Sepsis/shock: find abscess
Psuedomonas Common in pxw/ healthcare
→
Enterococci ex POSSUM
PYEIO : hypodenselesions
→ CT scan: study of choice.
SAMS/SAMR dueto ischemia by
neutro philic infiltra tion & may be normal in mild infection
Strep B edema
Candida
Diagnosis (ACUTI)
Symptoms of cystitis + pyuria/bacteriu
?1o
Clinic Asymp bact
:
Flank pain/tenderness + pyuria/bacter
Cystitis: dysuria, urinary freq/urg, Fever or sepsis without localizing
W or W /o
suprapubic pain, hematuria pyuria symptoms + pyuria and bacteriuria
Pyelo: fever, chills, flank pain,
costovertebral tenderness, vomits. Management
Atypical pain in epigastrium or LA Indications for hospitalization
Septic or critically ill
Complications Persistent >38.4ºC
Sepsis, bacteremia, shock, acute Pain
Marked debility or dehydration
renal failure (obstruction, recent qx,
Concerns with adherence
DM). Abscess, papillary necrosis
Suspected obstruction
