Urine & Cystitis Therapy - Assya

I. Urinalysis

• Leukocyte Esterase: Lysis of urine granulocytes, due to inflammation
• WBC: More than 10 WBC/HPF
• Nitrites: Due to nitrate-reducing bacteria
• Bacteria: Infection or contamination
• Squamous Cells: Urethra or external genitalia >3, probably contaminated. 

   
    Most Common Pathogens

• Ecoli 
• Staph Saprophyticus
• Other Gram Negative

II. Spectrum of Disease

• Asymptomatic Bacteriuria: 5% of premenopausal females and 25-50% of long-term care facility residents are colonized and asymptomatic. Pregnancy should be the only reason we screen for asymptomatic bacteriuria. There is no clinical benefit to treating asymptomatic bacteriuria with antibiotics (except pregnant females)
• Uncomplicated Cystitis: If a female has dysuria and frequency, without vaginal discharge, the likelihood of a UTI is 90%. Positive Nitrites and Leukocyte Esterase positive are 82% sensitive. Cultures are not needed unless they have a history of multiple UTIs in recent past. Young women normally recover without ABX in <7 days, and are not at risk for pyelonephritis. 
  • 1st Line: Nitrofurantoin x5 days or TMP/SMX x3 days
  • 3rd Line: Fluoroquinolones x3 days
  • 4th Line: Beta Lactams x3-7 days
• Catheter-Associated UTI: (CAUTI): change in symptoms, non-urologic symptoms, or "sense of unease"  or increased spacicity in spinal cord injured patients. Diagnosis requires a culture of >1,000 CFU/mL. Do not rely on odor or appearance, do not screen urine. You must exchange the foley and then sample. Treat with a long course of antibiotics (recommendations vary). 
  • Foley >48 hours
  • Self-catheterization
  • >2 weeks has significant biofilms
  • Organism in the Urine bag is not always the bacteria in the bladder.