Cystitis - Uncomplicated vs Complicated UTI
Uncomplicated ...

Cystitis - Uncomplicated vs Complicated UTI

Uncomplicated UTI

 • Diagnosis: Clinical; UA can be used to confirm; pyuria (>10wbc) has NPV>PPV

     o Women: If dysuria and ↑ frequency without vaginal discharge/irritation, >90% likelihood of UTI. In outpt, UA unnecessary unless immunocomp. or w/ risk factors for compl UTI

     o In outpt, get UCx only if atypical sx, persist 48-72 hr after abx initiated, or recur w/in 3 mos of tx

     o Nitrites: only positive with Enterobacteriaceae (convert urinary nitrate to nitrite)

 • Differential Diagnosis: vaginitis, urethritis, structural abnormality, PID, nephrolithiasis

 • Microbiology: E. coli, Klebs, Proteus, S. Saprophyticus. Enterococc. rarely causes true infxn

Complicated UTI

 • Definition: UTI + systemic s/sx. Uncomp/complic distinction not strict, some guidelines include structural/fnxl GU tract abnormality, DM2, stones, etc.

 • 30% pts w/ UTI and fever are bacteremic (usually older, flank / suprapubic pain, ↑ CRP, ↓ BP)

 • Pyelonephritis is a complicated UTI, may itself be complicated by perinephric or renal abscess)

     o WBC casts on UA are suggestive of pyelo

 • Microbiology: same as UTI plus Serratia, Morganella, Providencia, Pseudomonas, Citrobacter. Grampositives still rare. If S. aureus, think bacteremia. Increasingly resistant organisms (especially to FQ,TMP/SMX)

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