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For the Chapter in the Schwinghammer Handbook, please go to Chapter 51, Urinary Tract Infections and Prostatitis.



  • imageUrinary tract infections (UTIs) can be classified as uncomplicated and complicated. Uncomplicated refers to an infection in an otherwise healthy, premenopausal 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, premenopausal adult female.

  • imageRecurrent 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 because of unsuccessful treatment of the original infection, a resistant organism, or anatomical abnormalities.

  • imageThe majority (75%-90%) of uncomplicated UTIs are caused by Escherichia coli and the remainder are caused primarily by Staphylococcus saprophyticus, Proteus spp., and Klebsiella spp. Complicated infections may be associated with other gram-negative organisms and Enterococcus faecalis.

  • imageSymptoms of lower UTIs include dysuria, urgency, frequency, nocturia, and suprapubic heaviness, whereas upper UTIs involve more systemic symptoms such as fever, nausea, vomiting, and flank pain.

  • imageSignificant bacteriuria has been defined as bacterial counts of greater than 105 organisms (colony-forming unit [CFU])/mL (108 CFU/L) of a midstream clean catch urine. However, this is too general and significant bacteriuria in patients with symptoms of UTI may be defined as greater than 102 organisms (CFU)/mL (105 CFU/L).

  • imageThe goals of treatment of UTIs are to eradicate the invading organism(s), prevent or treat systemic consequences of infections, prevent the recurrence of infection, and prevent antimicrobial resistance.

  • imageUncomplicated UTIs can be managed most effectively with short-course therapy (3 days) with either trimethoprim–sulfamethoxazole, one dose of fosfomycin, or 5 days of nitrofurantoin. Fluoroquinolones should be reserved for suspected pyelonephritis or complicated infections.

  • imageWhen choosing appropriate antibiotic therapy, practitioners need to be cognizant of antibiotic resistance patterns, particularly to E. coli. Trimethoprim–sulfamethoxazole has diminished activity against E. coli in some areas of the country, with reported resistance in some areas greater than 20%.

  • imageAcute bacterial prostatitis can be managed with many agents that have activity against the causative organism. Chronic prostatitis requires prolonged therapy with an agent that penetrates the prostatic tissue and secretions. Therapy with fluoroquinolone or trimethoprim–sulfamethoxazole is preferred for up to 6 weeks.



EY, a 28-year-old pregnant female presents to her OB clinic for a routine week 18 appointment. Her past medical history is unremarkable except for seasonal allergies. In the clinic, she is hemodynamically stable with a BP 130/72 mm Hg, HR 78 BPM, RR 16, and temperature 97.5°F (36.4°C). Her home medications ...

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