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Urinary Tract Infections for PA

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Urinary Tract Infections for the Physician Assistant Licensing Exam
  • Definition:
    • Urinary tract infections (UTIs) involve microbial infection of the urethra, bladder, ureters, or kidneys. UTIs are categorized into lower UTI (cystitis) and upper UTI (pyelonephritis) depending on the infection site.
  • Etiology:
    • The most common pathogen is Escherichia coli (75-95% of cases). Other pathogens include:
    • Staphylococcus saprophyticus, Proteus mirabilis, Klebsiella pneumoniae, and Enterococcus.
    • Fungal UTIs (typically caused by Candida) are more common in patients with indwelling catheters or those who are immunocompromised.
  • Risk Factors:
    • Female anatomy (shorter urethra) increases the risk of UTIs.
    • Sexual activity and postmenopausal changes (decreased estrogen).
    • Urinary stasis due to obstruction (e.g., benign prostatic hyperplasia [BPH], kidney stones) or vesicoureteral reflux.
    • Catheterization and diabetes (impaired immune function).
  • Clinical Features:
    • Lower UTI (Cystitis):
    • Dysuria: Painful urination.
    • Urinary frequency and urgency: Frequent need to void with urgency.
    • Suprapubic pain and possibly hematuria.
Cystitis urine output
    • Upper UTI (Pyelonephritis):
    • Fever, chills, and flank pain.
    • Nausea, vomiting, and systemic symptoms.
  • Diagnosis:
    • Urinalysis: Positive nitrites (indicative of gram-negative bacteria) and leukocyte esterase (indicating pyuria).
    • Urine culture: Confirms diagnosis, especially in complicated or recurrent cases (≥10⁵ CFU/mL).
    • Imaging (e.g., ultrasound) may be needed in recurrent or complicated cases to evaluate for obstruction or abscess.
  • Management:
    • Uncomplicated UTI:
    • First-line antibiotics: Nitrofurantoin (5 days), trimethoprim-sulfamethoxazole (TMP-SMX) (3 days), or fosfomycin (single dose).
    • Hydration and symptomatic relief with phenazopyridine (short-term).
    • Complicated UTI:
    • Longer antibiotic courses (7-14 days) and tailored therapy based on urine culture.
    • IV antibiotics for severe pyelonephritis or urosepsis.
    • Recurrent UTI:
    • Consider prophylactic antibiotics in frequent cases, along with behavioral modifications (e.g., hydration, post-coital voiding).
Key Points
  • UTIs are mainly caused by Escherichia coli, affecting the bladder (cystitis) or kidneys (pyelonephritis).
  • Diagnosis is based on urinalysis and confirmed by urine culture, especially for complicated cases.
  • Uncomplicated UTIs are treated with short courses of antibiotics, while complicated infections require longer therapy and possibly IV antibiotics.
  • Prevention of recurrent UTIs includes behavioral modifications and prophylactic antibiotics in selected cases.

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