1 / 13

UTIs

UTIs. Goals Understand the diagnostic accuracy of history, physical and lab findings. Know appropriate management of uncomplicated vs. complicated UTIs . UTIs. Very common – 50% of women will have at least 1 UTI Definitions Lower UTIs – urethritis and cystitis

makana
Télécharger la présentation

UTIs

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. UTIs Goals Understand the diagnostic accuracy of history, physical and lab findings. Know appropriate management of uncomplicated vs. complicated UTIs.

  2. UTIs • Very common – 50% of women will have at least 1 UTI • Definitions • Lower UTIs – urethritis and cystitis • Upper UTIs – pyelonephritis and peri-nephric abscess • Upper UTIs are more likely if fever, flank pain, CVAT, nausea or vomiting

  3. Diagnosis • Women are fairly accurate in self-diagnosing UTIs • 50% of women presenting with UTI symptoms as a chief complaint will have a culture-proven UTI

  4. Differential Diagnosis • Vaginitis –gardnerella, candida, trichomonas • Cervicitis – chlamydia, gonorrhea • HSV

  5. General History • Historical features indicating a greater risk of UTI • Previous history of UTI • Recent sexual activity

  6. Diagnosis • Presence of dysuria and frequency and absence of vaginal discharge and vaginal irritation = very high likelihood of UTI

  7. Diagnosis Physical exam findings are less accurate

  8. Cases • 24 yo healthy female c/o dysuria and frequency • 2 prior UTIs • Currently sexually active in a monogamous relationship and using condoms • Denies vaginal symptoms Pre-test probability = 50% Likelihood ratio = 24.6 Post-test probability = 96%

  9. Cases • 20 yo healthy female c/o dysuria and frequency • Also c/o vaginal discharge and irritation • Sexually active in a monogamous relationship with intermittent condom usage • Dipstick u/a is normal Pre-test probability = 50% Likelihood ratios = 1.5, 1.8, 0.3, 0.2 Post-test probability = 20%

  10. Complicated vs. Uncomplicated • Uncomplicated – healthy female • Complicated – any male, any functional or anatomic abnormality • Diabetes • Immunosuppression • Pregnancy • Indwelling catheter • Neurogenic bladder • Recent urinary tract instrumentation • Polycystic renal disease • Nephrolithiasis

  11. Treatment • Uncomplicated • 80% E. Coli • Treat with tmp/smx, nitrofurantoin, or ciprofloxacin depending on local resistance pattern • Duration – 3 days (5 days nitrofurantoin) • Complicated • Broader range of organisms (proteus, klebsiella, pseudomonas, serratia, enterococci) • Organisms more likely to be resistant • Usually treat with quinolone (ciprofloxacin 500 mg bid or levofloxacin 500 mg or 750 mg daily) • Duration – 7 to 14 days

  12. Summary • Combination of dysuria and urinary frequency in the absence of vaginal symptoms has high likelihood of UTI • Uncomplicated UTIs are managed differently than complicated UTIs

  13. Reference • Bent et al. Does this woman have an acute uncomplicated urinary tract infection? JAMA 2002;287:2701-20.

More Related