Clinical Presentation and Diagnosis of UTIs General

• Most women present with hematuria; however, this is not a presentation restricted only to UTIs.

• Elderly patients frequently will not present with common signs and symptoms of UTI, but may present with altered mental status.

• More than 95% of UTIs are caused by a single organism.

• Patients may present with urosepsis.

Signs and Symptoms of Lower UTI

• Dysuria, gross hematuria, suprapubic heaviness, nocturia, increased urinary frequency and urgency

Signs and Symptoms of Upper UTI

• Fever, nausea, vomiting, malaise, and often severe flank pain Laboratory Tests

Urinalysis should show:

• Pyuria typically greater than 10 white blood cells/mm urine

• Bacteriuria, usually greater than 105 CFU organisms/mL

• Nitrites present

• Leukocyte esterase present Other Diagnostic Tests

• Bacterial urine culture

• Upper UTI: presence of costovertebral tenderness Risk Factors

There are several risk factors for development of UTIs.8 Common risk factors for UTIs in women include sexual intercourse, use of a diaphragm, use of spermicidal jellies, diabetes, and pregnancy.24-26 In men, the risks primarily relate to lack of circumcision and at an older age include prostatic hyperplasia. Common risk factors for both men and women include urologic instrumentation, renal transplantation, neurogenic bladder, and urinary tract obstruction.27,28

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