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Diagnosis, Treatment, and Prevention of Urinary Tract Infection

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  • Authors: Paula Pietrucha-Dilanchian1, Thomas M. Hooton2
  • Editors: Matthew A. Mulvey3, Ann E. Stapleton4, David J. Klumpp5
  • VIEW AFFILIATIONS HIDE AFFILIATIONS
    Affiliations: 1: Department of Medicine, University of Miami Miller School of Medicine, Miami, FL 33136; 2: Department of Medicine, University of Miami Miller School of Medicine, Miami, FL 33136; 3: University of Utah, Salt Lake City, UT; 4: University of Washington, Seattle, WA; 5: Northwestern University, Chicago, IL
    • Source: microbiolspec December 2016 vol. 4 no. 6 doi:10.1128/microbiolspec.UTI-0021-2015
  • Received 02 November 2015 Accepted 14 November 2016 Published 16 December 2016
  • Thomas M. Hooton, [email protected]
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  • Abstract:

    UTI may involve the lower or upper urinary tract and may be uncomplicated or complicated. The emphasis of this chapter is uncomplicated UTI. The diagnosis of uncomplicated cystitis (bladder infection) and pyelonephritis (kidney infection) is usually easily made based on the clinical presentation, whereas the diagnosis in patients with complicated UTI is often more complex. Thus uncomplicated cystitis is usually manifested by dysuria, frequency and/or urgency without fever, and pyelonephritis is usually manifested by fever and back pain/costovertebral angle tenderness. However, pyuria is usually present with UTI, regardless of location, and its absence suggests that another condition may be causing the patient’s symptoms. Treatment of cystitis is usually straightforward with one of several effective short-course antimicrobial regimens, although antimicrobial resistance continues to increase and can complicate treatment choices in certain areas. Likewise, antimicrobial resistance has complicated our management of uncomplicated pyelonephritis since resistance of uropathogens to the fluoroquinolone class, the mainstay of oral treatment for pyelonephritis, is increasing worldwide, and some of the other agents used for cystitis are not recommended for pyelonephritis due to low tissue levels. The goal of prevention of recurrent cystitis is to minimize the use of antimicrobials and there are several research efforts in progress to develop effective and safe antimicrobial-sparing preventive approaches for this common condition.

  • Citation: Pietrucha-Dilanchian P, Hooton T. 2016. Diagnosis, Treatment, and Prevention of Urinary Tract Infection. Microbiol Spectrum 4(6):UTI-0021-2015. doi:10.1128/microbiolspec.UTI-0021-2015.

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/content/journal/microbiolspec/10.1128/microbiolspec.UTI-0021-2015
2016-12-16
2021-04-23

Abstract:

UTI may involve the lower or upper urinary tract and may be uncomplicated or complicated. The emphasis of this chapter is uncomplicated UTI. The diagnosis of uncomplicated cystitis (bladder infection) and pyelonephritis (kidney infection) is usually easily made based on the clinical presentation, whereas the diagnosis in patients with complicated UTI is often more complex. Thus uncomplicated cystitis is usually manifested by dysuria, frequency and/or urgency without fever, and pyelonephritis is usually manifested by fever and back pain/costovertebral angle tenderness. However, pyuria is usually present with UTI, regardless of location, and its absence suggests that another condition may be causing the patient’s symptoms. Treatment of cystitis is usually straightforward with one of several effective short-course antimicrobial regimens, although antimicrobial resistance continues to increase and can complicate treatment choices in certain areas. Likewise, antimicrobial resistance has complicated our management of uncomplicated pyelonephritis since resistance of uropathogens to the fluoroquinolone class, the mainstay of oral treatment for pyelonephritis, is increasing worldwide, and some of the other agents used for cystitis are not recommended for pyelonephritis due to low tissue levels. The goal of prevention of recurrent cystitis is to minimize the use of antimicrobials and there are several research efforts in progress to develop effective and safe antimicrobial-sparing preventive approaches for this common condition.

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Diagnosis, Treatment, and Prevention of Urinary Tract Infection
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Citation: Pietrucha-Dilanchian P, Hooton T. 2016. Diagnosis, treatment, and prevention of urinary tract infection. microbiolspec 4(6): doi:10.1128/microbiolspec.UTI-0021-2015
/content/microbiolspec/10.1128/microbiolspec.UTI-0021-2015.T1
TABLE 1

Empiric antimicrobials for acute uncomplicated cystitis

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TABLE 1

Empiric antimicrobials for acute uncomplicated cystitis

Source: microbiolspec December 2016 vol. 4 no. 6 doi:10.1128/microbiolspec.UTI-0021-2015
/content/microbiolspec/10.1128/microbiolspec.UTI-0021-2015.T2
TABLE 2

Empiric oral antimicrobials for outpatient management of acute uncomplicated pyelonephritis

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TABLE 2

Empiric oral antimicrobials for outpatient management of acute uncomplicated pyelonephritis

Source: microbiolspec December 2016 vol. 4 no. 6 doi:10.1128/microbiolspec.UTI-0021-2015
/content/microbiolspec/10.1128/microbiolspec.UTI-0021-2015.T3
TABLE 3

Empiric antimicrobials for inpatient management of acute uncomplicated pyelonephritis

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TABLE 3

Empiric antimicrobials for inpatient management of acute uncomplicated pyelonephritis

Source: microbiolspec December 2016 vol. 4 no. 6 doi:10.1128/microbiolspec.UTI-0021-2015
/content/microbiolspec/10.1128/microbiolspec.UTI-0021-2015.T4
TABLE 4

Antimicrobials for recurrent acute uncomplicated cystitis

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TABLE 4

Antimicrobials for recurrent acute uncomplicated cystitis

Source: microbiolspec December 2016 vol. 4 no. 6 doi:10.1128/microbiolspec.UTI-0021-2015

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