Urinary tract infections UTI

• Facts:
  Positive E.coli cultures found in 80% of cases
  Affects females > males
• History / PE:
  Dysuria, urgency, frequency, suprapubic pain
  Bed wetting (children)
• Diagnosis:
  Increased leukocyte esterase (marker of WBCs)
  Increased nitrites (marker of Enterobacteriaceae)
  Increased urine pH (proteus)
  Hematuria (seen with cystitis)
  Urine culture > 10^5 CFU/mL
  
• Treatment:
  Uncomplicated UTI
  Bactrim (first line) X 3 days
  Fluoroquinolone X 3 days
  Nitrofurantoin X 7 days
  Amoxicillin (Enterococcus)
  
  Complicated UTI
  (urinary obstruction, men, renal transplant, catheters)
  
  Treat with same ABx, but increase course to 7-14 days
  
  Pregnant patients
  Avoid fluoroquinolones
• Complications:
  Pyelonephritis (levofloxacin X 7 days)
• Pneumonic:
  Common UTI bugs ("SEEKS PP")
  
  S erratia marcescens (red pigment)
  E. coli
  E nterobacter
  K lebsiella pnuemoniae
  S. saphrophyticus
  
  P seudomonas
  P roteus (alkaline pH)
• Notes:
  Failure to improve with antibiotics is an indication for ultrasound to search for any underlying pathologies (eg. obstruction) or complications (eg. renal/perirenal abscess)