5-Minute Emergency Consult
Urinary Tract Infections, Adult
Basics
Description
Description
- Colonization of urine with uropathogens and invasion of genitourinary (GU) tract
- Defined as urinary symptoms with ≥102 to 105 CFU/mL of uropathogen and ≥10 WBC/mm3
- Lifetime risk of UTI in women is >50%
- Uncomplicated cystitis:
- Females aged 13–50
- Symptoms <2–3 d
- Not pregnant
- Afebrile (temperature <38°C)
- No flank pain
- No costovertebral angle tenderness (CVAT)
- Fewer than 4 UTIs in past year
- No recent instrumentation or previous GU surgery
- No functional/structural GU abnormality
- Not immunocompromised
- Neurologically intact
- Complicated cystitis:
- Do not meet above criteria
- Male gender
- Patients with anatomic, functional, or metabolic abnormalities of GU tract
- Postvoid residual urine
- Catheters
- Resistant pathogens
- Recent antimicrobial use
- Uncomplicated pyelonephritis:
- Renal parenchymal infection
- Dysuria, frequency, urgency
- Fever, chills, myalgias, nausea, vomiting
- Flank, back, or abdominal pain
- CVA tenderness
- Leukocytosis (common)
- Complicated pyelonephritis:
- Renal parenchymal infection
- Temperature >40°C
- Urosepsis with septic shock
- Intractable nausea, vomiting
- Diabetes, other immunosuppression
- Pregnancy (especially latter half)
- Concomitant obstruction or stone
- Asymptomatic (occult)
Etiology
Etiology
- Mechanism:
- Organisms colonize periurethral area and subsequently infect the GU tract
- Risk factors:
- Population:
- Newborn, prepubertal girls, young boys
- Sexually active young woman
- Postmenopausal woman, elderly males
- Behavior:
- Sexual intercourse, spermicides, diaphragms
- Population:
- Elderly females/postmenopausal state
- Less efficient bladder emptying, bladder prolapse, alteration of bladder defenses
- Increased vaginal pH
- Contamination due to urinary or fecal incontinence (Enterobacteriaceae)
- Instrumentation:
- Elderly males due to prostatic hypertrophy and instrumentation
- Organisms:
- Escherichia coli (80–85%)
- Staphylococcus saprophyticus (10%)
- Other (10%): Klebsiella, Proteus mirabilis, Enterobacter spp., Pseudomonas aeruginosa, group D streptococci
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Citation
Schaider, Jeffrey J., et al., editors. "Urinary Tract Infections, Adult." 5-Minute Emergency Consult, 6th ed., Lippincott Williams & Wilkins, 2020. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307484/1.2/Urinary_Tract_Infections_Adult.
Urinary Tract Infections, Adult. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307484/1.2/Urinary_Tract_Infections_Adult. Accessed December 30, 2024.
Urinary Tract Infections, Adult. (2020). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (6th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307484/1.2/Urinary_Tract_Infections_Adult
Urinary Tract Infections, Adult [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. [cited 2024 December 30]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307484/1.2/Urinary_Tract_Infections_Adult.
* Article titles in AMA citation format should be in sentence-case
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T1 - Urinary Tract Infections, Adult
ID - 307484
ED - Barkin,Adam Z,
ED - Shayne,Philip,
ED - Rosen,Peter,
ED - Schaider,Jeffrey J,
ED - Barkin,Roger M,
ED - Hayden,Stephen R,
ED - Wolfe,Richard E,
BT - 5-Minute Emergency Consult
UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307484/1.2/Urinary_Tract_Infections_Adult
PB - Lippincott Williams & Wilkins
ET - 6
DB - Emergency Central
DP - Unbound Medicine
ER -
