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  • Image not available. Urinary tract infections (UTIs) are classified as uncomplicated and complicated. Uncomplicated refers to an infection in an otherwise healthy female who lacks structural or functional abnormalities of the urinary tract. Most often complicated infections are associated with a predisposing lesion of the urinary tract; however, the term may be used to refer to all other infections, except for those in the otherwise healthy adult female.
  • Image not available. Recurrent UTIs are considered either reinfections or relapses. Reinfection usually happens more than 2 weeks after the last UTI, and is treated as a new uncomplicated UTI. Relapse usually happens within 2 weeks of the original infection and is a relapse of the original infection either because of unsuccessful treatment of the original infection, a resistant organism, or anatomical abnormalities.
  • Image not available. Eighty-five percent of uncomplicated urinary tract infections are caused by Escherichia coli, and the remainder are caused primarily by Staphylococcus saprophyticus, Proteus spp., and Klebsiella spp. Complicated infections are more frequently associated with gram-negative organisms and Enterococcus faecalis.
  • Image not available. Symptoms of lower urinary tract infections include dysuria, urgency, frequency, nocturia, and suprapubic heaviness, whereas upper urinary tract infections involve more systemic symptoms such as fever, nausea, vomiting, and flank pain.
  • Image not available. Significant bacteriuria traditionally has been defined as bacterial counts of greater than 100,000 (105)/mL of urine. Many clinicians, however, have challenged this as too general a statement. Indeed, significant bacteriuria in patients with symptoms of a urinary tract infection may be defined as greater than 102 organisms per milliliter.
  • Image not available. The goals of treatment of urinary tract infections are to eradicate the invading organism(s), prevent or treat systemic consequences of infections, and prevent the recurrence of infection.
  • Image not available. Uncomplicated urinary tract infections can be managed most effectively with short-course (3 days) therapy with either trimethoprim-sulfamethoxazole or a fluoroquinolone. Complicated infections require longer treatment periods (2 weeks) usually with one of these agents.
  • Image not available. In choosing appropriate antibiotic therapy, practitioners need to be cognizant of antibiotic resistance patterns, particularly to E. coli. Trimethoprim-sulfamethoxazole has demonstrated diminished activity against E. coli in some areas of the country, with reported resistance in some areas almost 30%.
  • Image not available. Acute bacterial prostatitis can be managed with many agents that have activity against the causative organism. Chronic prostatitis requires an agent that is not only active against the causative organism but also concentrates in the prostatic secretions. Therapy with trimethoprim-sulfamethoxazole or a fluoroquinolone is preferred for 4 to 6 weeks.

On completion of the chapter, the reader will be able to:

  • 1. Define the differences between uncomplicated and complicated urinary tract infections.
  • 2. Identify the most common organisms which cause urinary tract infections.
  • 3. Describe the various routes in which bacteria enter the urinary tract and cause infection.
  • 4. Discuss how host defense mechanisms and bacterial virulence factors play a role in the development of urinary tract infections.
  • 5. Describe the clinical presentation of lower and upper urinary tract infections.
  • 6. Evaluate the various laboratory tests utilized in the diagnosis of ...

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