The most common etiologic organism implicated in acute cystitis is Escherichia coli .
For uncomplicated acute cystitis, diagnosis may be made according to history alone.
For complicated cases of cystitis, urinalysis and culture are typically required as part of the diagnostic workup.
Complicating factors include anatomic or functional abnormalities within the urinary tract, male sex, pregnancy, immunosuppression (e.g., renal transplant), diabetes, incomplete voiding, indwelling urinary catheter, recent instrumentation, healthcare-associated infection, or history of infection with extended-spectrum beta-lactamase-producing organisms or other multi-drug resistant organisms.
Antibiotic therapy is the mainstay of treatment for both uncomplicated and complicated acute cystitis. Complicated cases require a longer and more aggressive antibiotics course.
Acute cystitis is a lower urinary tract infection affecting the urinary bladder. It is most commonly seen in young, sexually active women. Infection is usually the result of Escherichia coli, or other bacteria that are normally found in the gastrointestinal tract or vagina, being introduced into the urethra (e.g., during sexual intercourse). Acute cystitis can be classified as complicated or uncomplicated based on the presence or absence of anatomic or functional abnormalities within the urinary tract, or specific patient factors (e.g., immunosuppression) that affect how straightforward the infection is to treat.
History and exam
Key diagnostic factors
- suprapubic pain
- prior history of urinary tract infections (UTIs) and treatment history
Other diagnostic factors
- recent urinary tract instrumentation
- flank pain
- abdominal pain
- vaginal discharge
- vaginal pruritus
- structurally or functionally abnormal bladder
- frequent sexual intercourse
- history of UTI
- anatomic or functional abnormalities within the urinary tract
- spermicidal jelly
- urinary catheter
- asymptomatic bacteriuria during pregnancy or prior to urological surgery
- spinal cord injuries
- older age
- lack of circumcision
- age <15 years for first UTI
- new sex partner in past year
- UTI history in mother
- diaphragm use
- vaginal atrophy
- low socioeconomic status
1st investigations to order
- urine microscopy
- urine culture with sensitivity
Investigations to consider
- pregnancy test
uncomplicated urinary tract infection (UTI): nonpregnant
complicated UTI: nonpregnant
uncomplicated or complicated UTI: pregnant
at risk of chronic recurrent UTI
- Interstitial cystitis
- Guidelines on urological infections
- Recurrent uncomplicated urinary tract infections in women: AUA/CUA/SUFU guideline
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