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Non-STD Urinary Tract Infections

General Information

² The spectrum of UTI Urethritis, Cystitis, Prostatitis, Pyelonephritis, Uro-sepsis

² Urethritis can and is frequently asymptomatic, all others in the spectrum usually are symptomatic

² Incidence is more common in women however, as age approaches 65 years incidence is more equal

² Lower UTI’s involve the urethra and the bladder, upper UTI’s involve the kidneys

² Classification includes

· Uncomplicated

§ No functional or structural abnormalities

§ Males are always classified as complicated

§ Why are women more susceptible to UTI? Think anatomy

· Complicated

§ Males with a UTI

§ Congenital abnormality, stone, catheter, obstruction, BPH, neurologic conditions, poor bladder emptying

² When do you have a true infection and when don’t you?

· 100,000 organisms/ml or more (CFU/ml)

· <100,000 organisms/ml with symptoms (CFU/ml)

· this is for non-STD assessment based on a clean catch urine sample and culture

· urine WBC greater than 10 WBC/mm³ is pyuria which may be an infection, leukocyte esterase dipstick

· hematuria, proteinuria may be an infection

· Nitrate reduction to nitrite tests for gram negative uropathogens (does not detect P. aeruginosa or gram positive organisms)

Presentation

· Lower UTI

§ Dysuria (burning), frequency, urgency, nocturia, hematuria

· Upper UTI

§ Same as lower UTI but usually more severe and will also include;

§ Fever, flank pain, back pain, chills, nausea and vomiting, weakness, sweating and rigors

§ If progresses to uro-sepsis, pt looks ‘toxic’ and frequently has altered mental status, hypotension, increased WBC, bands and segs

§ Elderly patients may appear asymptomatic or may only present with altered mental status