Acute cystitis - Revision history

Rossdonaldson1: /* Pregnant Women */

2023-11-01T16:25:14Z

Pregnant Women

← Older revision		Revision as of 16:25, 1 November 2023
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	===Pregnant Women===		===Pregnant Women===
	*New ACOG guidelines: If asymptomatic, get a culture and only treat if >100k CFUs<ref>https://www.acog.org/clinical/clinical-guidance/clinical-consensus/articles/2023/08/urinary-tract-infections-in-pregnant-individuals</ref>		*New ACOG guidelines: If asymptomatic, get a culture and only treat if >100k CFUs<ref>Urinary Tract Infections in Pregnant Individuals
			Clinical Consensus. Number 4, August 2023. https://www.acog.org/clinical/clinical-guidance/clinical-consensus/articles/2023/08/urinary-tract-infections-in-pregnant-individuals</ref>

	==See Also==		==See Also==

Rossdonaldson1: /* Pregnant Women */

2023-11-01T16:24:08Z

Pregnant Women

← Older revision		Revision as of 16:24, 1 November 2023
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	===Pregnant Women===		===Pregnant Women===
	*~~Treat all cases of~~ asymptomatic ~~bacteriuria~~		*New ACOG guidelines: If asymptomatic, get a culture and only treat if >100k CFUs<ref>https://www.acog.org/clinical/clinical-guidance/clinical-consensus/articles/2023/08/urinary-tract-infections-in-pregnant-individuals</ref>

	==See Also==		==See Also==

Hoxbox: /* Definitions */

2022-02-25T15:40:33Z

Definitions

← Older revision		Revision as of 15:40, 25 February 2022
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	**Usually due to a different organism		**Usually due to a different organism
	**If patient has >3 recurrences in 1 yr consider tumor, calculi, [[diabetes]]		**If patient has >3 recurrences in 1 yr consider tumor, calculi, [[diabetes]]
			**For menopausal or postmenopausal women with recurrent infection consider empiric treatment for [[Atrophic_vaginitis\|genitourinary syndrome of menopause]] (GSM)<ref>Winter et al, UTIs and Estrogen: the Overlooked Link https://www.acepnow.com/article/utis-and-estrogen-the-overlooked-link/</ref>

	===Risk Factors===		===Risk Factors===

Rossdonaldson1: /* Elderly */

2020-05-02T09:35:52Z

Elderly

← Older revision		Revision as of 09:35, 2 May 2020
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	===Pregnant Women===		===Pregnant Women===
	*Treat all cases of asymptomatic bacteriuria		*Treat all cases of asymptomatic bacteriuria

	~~===Elderly===~~
	*Elderly patients with pyelonephritis: 20% present with primary respiratory or GI symptoms. Also 33% are afebrile.<ref>Norris DL, Young JD. UTI. EM Clin N Am. 2008; 26:413-30.</ref>

	==See Also==		==See Also==

Rossdonaldson1: /* Differential Diagnosis */

2020-05-02T09:25:33Z

Differential Diagnosis

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	*[[Pyelonephritis]]		*[[Pyelonephritis]]
	*Infected [[kidney stone]]		*Infected [[kidney stone]]
	*In female patients with dysuria, consider [[vaginitis]] ([[trichomoniasis]], [[candidiasis]]) or [[urethritis]] ([[N. gonorrhoeae]]/[[Chlamydia]])<ref>Norris DL, Young JD. UTI. EM Clin N Am. 2008; 26:413-30.</ref>

	{{Pelvic pain DDX}}		{{Pelvic pain DDX}}

Rossdonaldson1 at 09:24, 2 May 2020

2020-05-02T09:24:44Z

← Older revision		Revision as of 09:24, 2 May 2020
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	*[[Pyelonephritis]]		*[[Pyelonephritis]]
	*Infected [[kidney stone]]		*Infected [[kidney stone]]
			*In female patients with dysuria, consider [[vaginitis]] ([[trichomoniasis]], [[candidiasis]]) or [[urethritis]] ([[N. gonorrhoeae]]/[[Chlamydia]])<ref>Norris DL, Young JD. UTI. EM Clin N Am. 2008; 26:413-30.</ref>

	{{Pelvic pain DDX}}		{{Pelvic pain DDX}}
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	*Consider local resistance patterns (if >10-20% use a different agent)		*Consider local resistance patterns (if >10-20% use a different agent)
	*Avoid use of fluoroquinolones for uncomplicated cystitis if possible		*Avoid use of fluoroquinolones for uncomplicated cystitis if possible
	*Consider [[phenazopyridine]] 100-200mg TID after meals x 2 days for pain control (bladder analgesic)		*Consider [[phenazopyridine]] for dysuria symptoms
			**100-200mg TID after meals x 2 days for pain control (bladder analgesic)
			**Warn of discoloration of urine and tears. Don’t wear contact lens due to risk of staining.<ref>Norris DL, Young JD. UTI. EM Clin N Am. 2008; 26:413-30.</ref>

	;Complicated if:		;Complicated if:
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	**[[Fluoroquinolones]] should be initial antibiotic of choice		**[[Fluoroquinolones]] should be initial antibiotic of choice
	*Most acute cystitis is caused by typical pathogens or common [[STI]] organisms		*Most acute cystitis is caused by typical pathogens or common [[STI]] organisms

	===Pregnant Women===		===Pregnant Women===
	*Treat all cases of asymptomatic bacteriuria		*Treat all cases of asymptomatic bacteriuria

	==~~Pearls~~==		===Elderly===
	*In female patients with dysuria, consider [[vaginitis]] ([[trichomoniasis]], [[candidiasis]]) or [[urethritis]] ([[N. gonorrhoeae]]/[[Chlamydia]])<ref>Norris DL, Young JD. UTI. EM Clin N Am. 2008; 26:413-30.</ref>
	*Elderly patients with pyelonephritis: 20% present with primary respiratory or GI symptoms. Also 33% are afebrile.<ref>Norris DL, Young JD. UTI. EM Clin N Am. 2008; 26:413-30.</ref>		*Elderly patients with pyelonephritis: 20% present with primary respiratory or GI symptoms. Also 33% are afebrile.<ref>Norris DL, Young JD. UTI. EM Clin N Am. 2008; 26:413-30.</ref>
	*[[Phenazopyridine]] for dysuria symptoms: Be sure to warn of discoloration of urine and tears. Don’t wear contact lens due to risk of staining.<ref>Norris DL, Young JD. UTI. EM Clin N Am. 2008; 26:413-30.</ref>

	==See Also==		==See Also==

Rossdonaldson1: /* PearlsNorris DL, Young JD. UTI. EM Clin N Am. 2008; 26:413-30. */

2020-05-02T09:22:33Z

PearlsNorris DL, Young JD. UTI. EM Clin N Am. 2008; 26:413-30.

← Older revision		Revision as of 09:22, 2 May 2020
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	*Treat all cases of asymptomatic bacteriuria		*Treat all cases of asymptomatic bacteriuria

	==Pearls~~<ref>Norris DL, Young JD. UTI. EM Clin N Am. 2008; 26:413-30.</ref>~~==		==Pearls==
	*In female patients with dysuria, consider [[vaginitis]] ([[trichomoniasis]], [[candidiasis]]) or [[urethritis]] ([[N. gonorrhoeae]]/[[Chlamydia]])		*In female patients with dysuria, consider [[vaginitis]] ([[trichomoniasis]], [[candidiasis]]) or [[urethritis]] ([[N. gonorrhoeae]]/[[Chlamydia]])<ref>Norris DL, Young JD. UTI. EM Clin N Am. 2008; 26:413-30.</ref>
	*Elderly patients with pyelonephritis: 20% present with primary respiratory or GI symptoms. Also 33% are afebrile.		*Elderly patients with pyelonephritis: 20% present with primary respiratory or GI symptoms. Also 33% are afebrile.<ref>Norris DL, Young JD. UTI. EM Clin N Am. 2008; 26:413-30.</ref>
	*[[Phenazopyridine]] for dysuria symptoms: Be sure to warn of discoloration of urine and tears. Don’t wear contact lens due to risk of staining.		*[[Phenazopyridine]] for dysuria symptoms: Be sure to warn of discoloration of urine and tears. Don’t wear contact lens due to risk of staining.<ref>Norris DL, Young JD. UTI. EM Clin N Am. 2008; 26:413-30.</ref>

	==See Also==		==See Also==

Rossdonaldson1: /* Background */

2020-05-02T09:18:43Z

Background

← Older revision		Revision as of 09:18, 2 May 2020
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	''This page is for adult patients; see [[urinary tract infection (peds)]] for pediatric patients.''		''This page is for adult patients; see [[urinary tract infection (peds)]] for pediatric patients.''
	==Background==		==Background==
			[[File:2605 The Bladder.jpg\|thumb\|Anatomy of the bladder (male)]]
	{{UTI types}}		{{UTI types}}

Rossdonaldson1: /* Evaluation */

2020-05-02T09:09:33Z

Evaluation

← Older revision		Revision as of 09:09, 2 May 2020
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	==Evaluation==		==Evaluation==
			[[File:Pyuria2011.jpg\|thumb\|Urine with pyuria.]]
	===Urine Analysis (UA)===		===Urine Analysis (UA)===
	====WBC count====		====WBC count====

Lyssa1219: /* WBC count */

2020-04-20T19:51:40Z

WBC count

← Older revision		Revision as of 19:51, 20 April 2020
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	*WBC >5 in patient with appropriate symptoms is diagnostic		*WBC >5 in patient with appropriate symptoms is diagnostic
	**Lower degrees of pyuria may still be clinically significant in presence of symptoms		**Lower degrees of pyuria may still be clinically significant in presence of symptoms
	***False negative may be due to: dilute urine, systemic leukopenia, obstruction		***False negative may be due to: dilute urine, systemic leukopenia, obstruction, recent antibiotic use with incomplete treatment
	**WBC 1-2 with bacteriuria can be significant in men		**WBC 1-2 with bacteriuria can be significant in men
	***More likely represents [[urethritis]] or [[prostatitis]] from [[STI]]		***More likely represents [[urethritis]] or [[prostatitis]] from [[STI]]