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Pathophysiology

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  • Epidemiology: most common bacterial infection; 50–80% of women ≥1 in lifetime
  • Pathogenesis: majority via ascending pathway (infectious organism ascends urethra); hematogenous spread (from bloodstream), very rare
  • Approach to characterization:
    • Healthcare associated (≥48h after admission) vs community acquired
    • Chronic (persistent [>2wk] or recurrent UTI [≥2 episodes in 6mo]) vs acute
    • Site: cystitis (bladder, urethra) vs pyelonephritis (kidney) vs prostatitis (prostate)
    • Uncomplicated → infection in otherwise healthy nonpregnant adult
    • Complicated → ↑ risk of treatment failure → ♂ (vast majority ♂ UTIs considered complicated → infants, elderly, urologic abnormalities), pregnant, unusual (or highly resistant) pathogen, DM, renal transplant, immunosuppression, history of pyelonephritis within past year, functional or structural abnormality

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Table Graphic Jump Location
Table 28-1 Abnormalities Associated with Complicated UTI
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Diagnosis & Evaluation

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Table Graphic Jump Location
Table 28-2 Common Signs & Symptoms
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Urine collection: midstream clean-catch recommended; other collection methods: indwelling catheter, ileal conduit, straight catheterization, suprapubic catheter, cystoscopy (do not use specimen from 24h urine collection)

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  • Urine culture: order with urinalysis (UA) or as follow up to abnormal UA; recommended for complicated UTI, healthcare-associated UTI, suspected pyelonephritis, relapse or persistent infection after initial therapy
  • + urine culture: high colony count (≥100,000CFU/mL = significant bacteriuria) of single bacterial type → probable ...

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