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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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Diagnosis & Evaluation
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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 ...