Urinary tract infections (UTIs)

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Headshot of Joanna Breems, MD, FACP · Clinical Assistant Professor
Joanna Breems
MD, FACP · Clinical Assistant Professor
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Table of Contents

Learning goals

  1. Compare epidemiology, microbiology, pathogenesis, and host risk factors for cystitis, pyelonephritis, and health-care associated urinary infections
  2. Compare and contrast the clinical presentations, diagnosis, treatment approach, and potential complications for cystitis, pyelonephritis, and prostatitis

This session covers the clinical entity of urinary tract infections and will build off of concepts/learning in the session on gram-negative pathogens. The focus of this session is the epidemiology, diagnosis, classification, and approach to treatment of infections along the genitourinary tract.

Active learning companion

This activity is provided to help you pick out most relevant concepts from the reading and RWJF video. (Take a screen shot, and fill in your answers with your Apple Pencil.)

Levinson W, Chin-Hong P, Joyce EA, Nussbaum J, Schwartz B. eds. Review of Medical Microbiology & Immunology: A Guide to Clinical Infectious Diseases, 16e. Chapter 78: Urinary Tract Infections

  1. The primary way that urinary infections occur is _____________________________________
  2. The main findings on urine dipstick in urinary tract infections are:
    • ________________________________
    • ________________________________
    • ________________________________
  3. Cystitis is more common in women due to _________________________________________.
  4. In setting of urinary tract infection, the presence of fever or systemic symptoms indicates ______________________________________________________________________
  5. The most common cause of cystitis is ________________________________
  6. True or False: Pseudomonas is a common cause of UTIs.
  7. The most common gram-positive bacteria to cause UTIs is ____________________________
  8. The diagnosis of UTI requires
    • ____________________________
    • PLUS ____________________________
    • PLUS ____________________________
  9. True or False: Patients with pyelonephritis do not always have symptoms of cystitis at presentation.
  10. True or False: The most common bacteria to cause pyelonephritis are different than common causes of cystitis.
  11. Finding _________________ on urine microscopy suggests diagnosis of pyelonephritis.
  12. True or False: The presence of pyuria in asymptomatic bacteria is an indication for antibiotics.

RWJF: UTIs

  1. Urethritis is more often caused by ____________________________________________________________________________
  2. Risk factors for UTIs include:
    •  
    •  
    •  
    •  
    •  
    •  
  3. A uropathogen is a ____________________________________________________________________________
  4. A UTI is considered complicated in any scenario where a patient is
    ____________________________________________________________________________
  5. Costovertebral angle tenderness is often a sign of
    •  
    •  
  6. True or False: Pyuria is sensitive but not very specific.
  7. The first line antibiotic for uncomplicated cystitis are:
    •  
    •  
    •  

(Don’t stress. We’ll cover these specific agents—their mechanism of action, spectrum of activity, and side effects—in sessions on antibiotics.)

Answer sheet

Levinson W, Chin-Hong P, Joyce EA, Nussbaum J, Schwartz B. eds. Review of Medical Microbiology & Immunology: A Guide to Clinical Infectious Diseases, 16e. Chapter 78: Urinary Tract Infections

  1. The primary way that urinary infections occur is ascension of normal enteric flora through the urethra to the bladder.
  2. The main findings on urine dipstick in urinary tract infections are
    • Pyuria
    • Hematuria
    • Bacteria
  3. Cystitis is more common in women due to short urethra and close approximation of urethra to vagina and anus.
  4. In setting of urinary tract infection, the presence of fever or systemic symptoms indicates likely upper tract involvement (pyelonephritis).
  5. The most common cause of cystitis is E.coli.
  6. False. Pseudomonas is a common cause of UTIs.
  7. The most common gram-positive bacteria to cause UTIs is Staphylococcus saprophyticus.
  8. The diagnosis of UTI requires
    • Evidence of infection in urinalysis
    • PLUS culture
    • PLUS symptoms.
  9. True. Patients with pyelonephritis do not always have symptoms of cystitis at presentation.
  10. False. The most common bacteria to cause pyelonephritis are different than common causes of cystitis.
  11. Finding WBC casts on urine microscopy suggests diagnosis of pyelonephritis.
  12. False. The presence of pyuria in asymptomatic bacteria is an indication for antibiotics.

 

RWJF: UTIs

  1. Urethritis is more often caused by sexually transmitted infections.
  2. Risk factors for UTIs include:
    • Recent intercourse
    • History of UTIs
    • Diabetes
    • Prostatic hypertrophy
    • Congenital urinary tract infections
    • Indwelling urinary catheters/Foley catheter.
  3. A uropathogen is a bacteria with predilection for attaching to the urinary epithelium.
  4. A UTI is considered complicated in any scenario where a patient is more likely to fail therapy typically used for an uncomplicated infection.
  5. Costovertebral angle tenderness is often a sign of pyelonephritis or nephrolithiasis.
  6. True. Pyuria is sensitive but not very specific.
  7. The first line antibiotic for uncomplicated cystitis are
    • Nitrofurantoin
    • Trimethoprim-sulfamethoxazole
    • Fosfomycin. 

Study materials

These are not required; they are supplementary to the large-group session. They are intended as a curated guide to content focused on the learning objectives. There are both textbook and video resources for this session for students to use per their preference.

For each reference, I have designated the learning goal addressed with a learning goal icon and and number.

Click the  blue icons below to go to the resources listed.

  • Novan's notes: UTIs

    This is a document prepared by Dr. George Novan with compiled key-points for UTIs (16 pages).