白袍恐懼症

UTI

1.      Introduction

Bacterial infection that affects any part of the urinary tract.

Lower: urethritis, cystitis

Upper: pyelonephritis, renal or perinephric abscess, prostatitis

2.      classification

(1). Uncomplicated UTI: acute cystitis (most common) in non-pregnant women without underlying structural or neurological disease

(2). Complicated UTI:

-pregnant

-immunosuppression

-anatomy: VUR, ureter duplication, urolithiasis, tumor, BPH, male

-on Foley catheter

3.      microbiology

-Uncomplicated UTI: 80% E. coli

-Complicated UTI: 30% E. coli, 20% enterococci, 20% pseudomonas

-Catheter-associated: 30% yeast, 20% E. coli

-emphysematous APN: DM patients 最多，以E. coli為主

-if treat with anti 後持續fever 3~5 days→小心是Complicated UTI，須做KUB, renal echo

4.      symptoms

Upper tract: fever, chills, flank pain, N/V, abdominal pain, diarrhea

<p.s.>chronic prostatitis: 和cystitis症狀類似，加上obstruction 的症狀

Acute prostatitis: perineal pain, fever, tenderness on DRE

Lower tract (ex. acute cystitis): dysuria, urgency, frequency, hematuria, suprapubic pain (通常不會fever)

Young children: diarrhea, loss of appetite, nausea and vomiting, fever, and excessive crying that cannot be resolved by typical measures.

5.      Diagnosis

(1). Urinalysis: pyuria+ bacteriuria+/- hematuria

=> bacterial count> 100000 CFU/ml in asymptomatic women, > 1000 CFU/ml in men, > 100 CFU/ml in catheterized patients

=>nitrite: proteus, enterobacteria, K.P., E. coli會產生nitrite，只有25% 會出現反應，但檢測出幾乎就能確定是UTI

=> leukocyte esterase: WBC active 才出現，75% 的敏感性, 陽性反應的話, 有64 % 的機會懷疑有pyuria

(2). Urine gram stain and culture

(3). History:排尿習慣(有無不正常的憋尿) 和排便衛生

(4). Sexual life: r/o STD

6.      比較

1: UTI

2: partial treatment(treat with anti), non-bacteria infection

3: asymptomatic bacteriauria→只有 pregency, pre-surgery, immunecomprise (use steroid, chemotherapy patient)才treat

4: neutropenia

5: GN (inflammation)

<p.s.>sterile pyuria: urethritis, renal tuberculosis, foreign body