In the name of GOD. URINARY TRACT INFECTION. Dr.Hedayati. Acute uncomplicated cystitis and pyelonephritis in women Acute uncomplicated cystitis, pyelonephritis, and asymptomatic bacteriuria in men Acute complicated cystitis and pyelonephritis
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Most episodes of cystitis and pyelonephritis are generally considered to be uncomplicated in otherwise healthy nonpregnantadult women.
recent sexual intercourse
recent spermicide use
history of urinary tract infection
use of TMP-SMX in the preceding 3 to 6 months was an independent risk factor for TMP-SMX resistance in women with acute uncomplicated cystitis.
Its absence : alternative diagnosis or
in a patient with pyelonephritis, the presence of an obstructing lesion .
negative results should be interpreted with caution
False positive nitrite tests can occur with substances that turn the urine red, such as phenazopyridine or ingestion of beets.
early clinical efficacy rate with 5 to 7 day regimen 90 to 95 %
Nitrofurantoin should be avoided :
if there is suspicion for early pyelonephritis,
is contraindicated when GFR<60 mL/minute.
early clinical efficacy rate with 3 to 7 day regimen 86 to 100 %
Empiric TMP-SMX should be avoided :
if the prevalence of resistance is known to exceed 20 %
if the patient has taken TMP-SMX for cystitis in the preceding 3 months
***Trimethoprim (100 mg twice daily for three days) is used in place of TMP-SMX and is considered equivalent
very effective for treatment of acute cystitis.
Fluoroquinolone resistance > 10 %, an initial intravenous dose of a long acting parenteral antimicrobial such as ceftriaxone (1 gram), should be administered.
It has been conventional to consider all UTIs (and presumably asymptomatic bacteriuria) in men as complicated, since the majority occur in infants or the elderly in association with urologic abnormalities, such as bladder outlet obstruction (eg, due to prostatic hyperplasia) or instrumentation.
History of acute pyelonephritis in the past year
Symptoms for seven or more days before seeking care
Antimicrobial resistant uropathogen
Hospital acquired infection
Urinary tract obstruction
Presence of an indwelling urethral catheter, stent, nephrostomy tube or urinary diversion
Recent urinary tract instrumentation
Functional or anatomic abnormality of the urinary tract
History of urinary tract infection in childhood
Acute complicated pyelonephritis is progression of upper urinary tract infection to emphysematous pyelonephritis, renal corticomedullary abscess, perinephric abscess, or papillary necrosis.
Chronic pyelonephritis is an uncommon cause of chronic tubulointerstitial disease due to recurrent infection, such as infection in association with a chronically obstructing kidney stone or vesicoureteral reflux.
patients with infection due to resistant organisms.
Avoiding treatment of asymptomatic bacteriuria is important for reducing development of antibiotic resistance, and a hospital and ambulatory performance measure for not treating asymptomatic bacteriuria in adults has been proposed