Acute Cystitis
Bladder infection, UTI
Acute Cystitis Etiology
Due to coliform bacteria (E coli) or G+ bacteria (enterococci)
- Infection ascends from urethra to bladder
- Rare in men and implies a pathologic process that requires further investigation
Acute Cystitis S/S
Dysuria, urinary frequency, urgency, usually afebrile
- Gross hematuria
- Suprapubic tenderness
Acute Cystitis Lab
UA: pyuria, hematuria, bacteriuria -leukocyte esterase and nitrites -WBCs and RBCs under scope Urine culture: pos Urine culture and sensitivity if empiric tx fails or an early relapse (less than 2 wks)
Acute Cystitis Management
Tx: Trimethroprim/ Sulfamethoxazole x 3 days
or Nitrofurantoin x 5 days
-Fluoroquinolone in pts with allergy but areas have high rates of resistance
Symptomatic relief: hot sitz baths or urinary analgesics
Acute Cystitis Prevention
-Complicated cases should be further investigated to determine the underlying cause
-Don’t use spermicide or diaphragm as birth control (for a variety of reasons…)
Women w/ 3+/year should get prophylactic abx therapy (single dose at bedtime or at time of intercourse)
Recurrent Cystitis Etiology
- Occurs after a documented infection has resolved
- due to: genetic predisposition, altered vaginal flora, post coital infection
Recurrent Cystitis S/S
Same as acute but quick relapse
Recurrent Cystitis Lab
Urine culture and sensitivity
-consider urologic work up to evaluate anatomical abnormalities
Recurrent Cystitis Management
Tx for 7-14 days
Asymptomatic bacteriuria Etiology
More common with older age, spinal cord injuries, hemodialysis pts
Asymptomatic bacteriuria S/S
No local or systemic symptoms can be present!!
-Usually discovered when undergoing unrelated urine culture screening
Asymptomatic bacteriuria Lab
Urine culture pos without symptoms
Asymptomatic bacteriuria Management
Do not treat!! Unless pregnant, before urologic intervention, prior to hip replacement, if they become symptomatic
Pyelonephritis
Infectious inflammatory disease involving the kidney parenchyma and renal pelvis
Pyelonephritis Etiology
Most common: E. coli, Proteus, Klebsiella, Enterobacter, Pseudomonas
Pyelonephritis S/S
Must have: Fever, flank pain, irritative voiding
-shaking chills, N/V/D, urgency, frequency, dysuria, tachycardia, costovertebral tenderness, HA
Pyelonephritis Lab
CBC
UA: pyuria, bacteriuria, hematuria, WBC casts
Urine culture: positive
US of bladder/kidney/ ureter to rule out obstruction
Pyelonephtitis Management
Inpatient: IV ampicillin and an aminoglycoside until afebrile for 24 hrs then oral abx x 3 wks
Outpatient: fluoroquinolone x 2 wks
Acute Bacterial Prostatitis Etiology
Usually caused by E coli or Pseudomonas
Acute Bacterial Prostatitis S/S
Fever; irritative voiding; pelvic pain; ‘exquisite” tenderness on rectal exam; tender prostate
-pain with ejaculation
Acute Bacterial Prostatitis Lab
Urine culture: pos
CBC: leurkocytosis and left shift
UA: pyuria, bacteriuria, hematuria
Acute Bacterial Prostatitis Management
Fluoroquinolone or TMP-SMX x 2-4 wks
Acutely ill - admit for IV abx: ampicillin and gentamicin plus above tx
Consider testing for HIV and other STIs
Acute Bacterial Prostatitis Prevention
Wear a condom with anal sex
Chronic Bacterial Prostatitis Etiology
-Usually a result of bladder outlet obstruction
G(-) rods
Less commonly Enterococcus
Chronic Bacterial Prostatitis S/S
Irritative voiding; dull and poorly localized low back, perineal or suprapubic discomfort; prostatic secretions
- Can be asymptomatic
- Many men have no history of acute infection!!
Chronic Bacterial Prostatitis Lab
Culture secretions or postprostatic massage urine specimen
UA: normal unless 2nd cystitis
Chronic Bacterial Prostatitis Management
Anti-inflammatory agent Tx: prolonged course of Fluoroquinolone or TMP-SMX -Refer to a urologist -Hot sitz bath -Relax pelvic floor with micturition
Chronic Bacterial Prostatitis Prevention
Difficult to cure!
-Symptoms and recurrent UTIs can be controlled with suppressive abx therapy
Epididymitis Etiology
Sexually transmitted: Chlamydia trachomatis or Neisseria gonorrhoeae
Nonsexually: G(-) rods
Epididymitis S/S
- Painful enlargement of the epididymis, relieved by scrotal elevation
- Fever, irritative voiding, scrotal swelling
- Pain in scrotum may radiate along spermatic cord
- urethral discharge
Epididymitis Lab
UA: pyuria, bacteriuria
Sexually: gram stain of discharge, test for CT/GC
Nonsexually: UA, urine culture
Epididymitis Management
Sexually: abx x 10-21 days; treat partner
Nonsexually: abx x 21-28 days; bed rest with scrotal elevation
Epididymitis Prevention
Delayed or inadequate tx may result in epidiymorchitis, decreased fertility, or abscess formation