Urinary tract infection

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Staph aureus cultured in urine: likely contaminant?
Not likely - do blood cultures, in case of haematogenous spread to urine
Salmonella cultured in urine: likely contaminant?
Not likely - do blood cultures, in case of haematogenous spread to urine
Which common causative organisms do not reduce nitrate to nitrite?
Pseudomonas (common in complicated UTIs), and Staphylococcus saprophyticus and enterococcus (common in uncomplicated UTIs)
Only enterobacteriaciea convert nitrates to nitrites.
Which symptoms can be consistent with pyelonephritis?
Fever, chills, flank pain, costovertebral angle tenderness, nausea and vomiting (with or without symptoms of cystitis)
Note that nausea and vomiting or very high fevers are indicative of "severe" pyelonephritis which must be treated with IV antibiotics
Should you do a urine culture in a patient with isolated cloudy urine?
Generally no
There is no utility in testing the urine of an asymptomatic patient (malodourous or cloudy urine is not a symptom) if you are not going to treat them. Only treat asymptomatic bacteriuria in pregnant women, patients about to have urological procedures and renal transplant recipients
Evidence-based prophylactic agents for use in patients with frequent UTIs?
Antibiotics (eg trimethoprim 150mg po daily continuously or in the 2 hours following intercourse for women)
No convincing evidence for cranberry products, probiotics or hexamine hippurate (but the latter MAY be effective in short courses)
Treatment of uncomplicated cystitis in non-pregnant females
Trimethoprim 300mg po daily for 3 days
Treatment of uncomplicated cystitis in males
Trimethoprim 300mg po daily for 7 days
Treatment of pyelonephritis
Mild (low fever, no nausea/vomiting): trimethoprim, augmentin DF or cephalexin (all equal first line) for 10 to 14 days
Severe: gentamycin + amoxycillin 2g IV q6H
Multi-drug resistant G-ve UTI: meropenem 500-1g IV q8H