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Chapter 44. Urinary Tract Infections and Prostatitis

Elizabeth A. Coyle; Randall A. Prince

A systematic search of the medical literature was performed on November 2006. The search included relevant articles from PubMed, Ovid, and guidelines from the Infectious Diseases Society of America.

Urinary tract infections (UTIs) are one of the most commonly occurring bacterial infections, accounting for millions of patient visits annually.1–3 Approximately one in three females will have had a UTI by their mid-twenties. In the older adults, infection rates in men and women are similar.

A UTI is defined as the presence of microorganisms in the urinary tract that cannot be accounted for by contamination. UTIs are classified by several methods. Commonly, describing them by anatomic site or as uncomplicated or complicated is most typical. The main classification method used in this chapter will be the categorization of UTIs as uncomplicated or complicated. Tables 44-1, 44-2, and 44-3 present summary lists on clinical presentation, diagnostic criteria, and empiric therapy.

Table 44-1. Diagnostic Criteria for Significant Bacteriuria
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Table 44-1. Diagnostic Criteria for Significant Bacteriuria
≥102> CFU coliforms/mL or ≥105 CFU noncoliforms/mL in a symptomatic female
≥103 CFU bacteria/mL in a symptomatic male
≥105 CFU bacteria/mL in asymptomatic individuals on two consecutive specimens
Any growth of bacteria on suprapubic catheterization in a symptomatic patient
≥102 CFU bacteria/mL in a catheterized patient

CFU, colony forming units.

Table 44-2. Clinical Presentation of Urinary Tract Infections in Adults
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Table 44-2. Clinical Presentation of Urinary Tract Infections in Adults
Signs and symptoms
Lower UTI: dysuria, urgency, frequency, nocturia, suprapubic heaviness
Gross hematuria
Upper UTI: Flank pain, fever, nausea, vomiting, malaise
Physical examination
Upper UTI: costovertebral tenderness
Laboratory tests
Bacteriuria
Pyuria (white blood cell count >10/mm3)
Nitrite-positive urine (with nitrite reducers)
Leukocyte esterase–positive urine
Antibody-coated bacteria (upper UTI)
Table 44-3. Empiric Treatment of Urinary Tract Infections and Prostatitis
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Table 44-3. Empiric Treatment of Urinary Tract Infections and Prostatitis
Infectious DiseaseCausative OrganismsTreatments
Uncomplicated UTIE. coli, S. saprophyticusTrimethoprim–sulfamethoxazole × 3–5 d
Quinolone × 3–5 d
Complicated UTI
PregnancyE. coli, S. saprophyticusAmoxicillin–clavulanate × 7 d
Cephalosporin × 7 d
Trimethoprim–sulfamethoxazole × 7 d (avoid during third trimester)
PyelonephritisE. coli, Proteus spp.,K. pneumoniae, P. aeruginosa,S. fecalisQuinolone × 14 d (oral for mild to moderate)
Trimethoprim–sulfamethoxazole × 14 days (oral for mild to moderate)
Extended spectrum penicillin plus aminoglycoside × 14 days (oral therapy may complete a total of 2 weeks of therapy)
Recurrent UTITrimethoprim–sulfamethoxazole, 1/2 single-strength tablet daily × 6 mo
Nitrofurantoin 50 mg daily × 6 mo (Suppressive therapy for >3 UTIs/yr)
Prostatitis
AcuteE. coli, K. pneumoniaeTrimethoprim–sulfamethoxazole × 4–6 wk
Quinolone × 4–6 wk (IV therapy may be needed initially)
ChronicE. coli, K. ...

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