Urinary tract infections in women can be clinically categorized into uncomplicated/complicated, acute, or recurrent.
Escherichia coli is the most common organism in uncomplicated infections.
Costovertebral angle tenderness together with fever suggests pyelonephritis.
Diagnosed using urine dipstick, microscopic urinalysis (bacteria, white blood cell, red blood cell), and urine culture.
Antibiotic selection should be guided by local bacterial susceptibilities and guidelines, or based on known urine culture and sensitivity.
A urinary tract infection (UTI) is an infection of the kidneys, bladder, or urethra. Infectious cystitis is the most common type of UTI, which is caused by a bacterial infection of the bladder. Pyelonephritis is an infection of the kidney that often occurs via bacterial ascent, and urethritis is an infection causing an inflammation of the urethra.
History and exam
Key diagnostic factors
- urinary frequency
- back/flank pain
- costovertebral angle tenderness
Other diagnostic factors
- urinary urgency
- suprapubic pain and tenderness
- sexual activity
- spermicide use
- positive family history of UTIs
- history of recurrent UTI
- presence of a foreign body
- insulin-treated diabetes
- high lifetime number of UTIs
- recent antibiotics
- poor bladder emptying
- increasing age
1st investigations to order
- urine dipstick
- urine microscopy
- urine culture and sensitivity
Investigations to consider
- postvoid residual (PVR)
- renal ultrasound
- abdominal/pelvic CT scan
complicated suitable for outpatient therapy: not pregnant
complicated suitable for outpatient therapy: pregnant
complicated requiring inpatient therapy: not pregnant
complicated requiring inpatient therapy: pregnant
uncomplicated recurrent (3 or more in 12 months): related to sexual intercourse
uncomplicated recurrent (3 or more in 12 months): unrelated to sexual intercourse
- Overactive bladder
- Urothelial carcinoma of the bladder or upper urinary tract
- Noninfectious urethritis
- Guidelines on urological infections
- Recurrent uncomplicated urinary tract infections in women
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