Genitourinary Infections

Genitourinary Infections is a topic covered in the Washington Manual of Medical Therapeutics.

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  • Urinary tract infections (UTIs) can be uncomplicated or complicated, depending on host factors and underlying conditions. Diagnostic and therapeutic approaches to adult genitourinary infections are determined by gender-specific anatomic differences, prior antimicrobial exposures, and the presence of catheters, stents, etc. Infections are primarily caused by Enterobacterales (E. coli, Proteus mirabilis, and K. pneumoniae) and Staphylococcus saprophyticus.
  • Workup includes urinalysis and microscopic examination of a fresh, unspun, clean-voided, or catheterized urine specimen. Pyuria (positive leukocyte esterase or ≥8 leukocytes per high-power field) or bacteriuria (positive nitrites or ≥1 organism per oil immersion field) suggests active infection if compatible symptoms are present. A high number of epithelial cells indicate an inadequate sample. A urine Gram stain can be helpful in guiding initial antimicrobial choices. Quantitative culture often yields >105 bacteria colony-forming units (CFU)/mL, but colony counts as low as 102–104 bacteria/mL may indicate infection in women with acute dysuria.

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  • Urinary tract infections (UTIs) can be uncomplicated or complicated, depending on host factors and underlying conditions. Diagnostic and therapeutic approaches to adult genitourinary infections are determined by gender-specific anatomic differences, prior antimicrobial exposures, and the presence of catheters, stents, etc. Infections are primarily caused by Enterobacterales (E. coli, Proteus mirabilis, and K. pneumoniae) and Staphylococcus saprophyticus.
  • Workup includes urinalysis and microscopic examination of a fresh, unspun, clean-voided, or catheterized urine specimen. Pyuria (positive leukocyte esterase or ≥8 leukocytes per high-power field) or bacteriuria (positive nitrites or ≥1 organism per oil immersion field) suggests active infection if compatible symptoms are present. A high number of epithelial cells indicate an inadequate sample. A urine Gram stain can be helpful in guiding initial antimicrobial choices. Quantitative culture often yields >105 bacteria colony-forming units (CFU)/mL, but colony counts as low as 102–104 bacteria/mL may indicate infection in women with acute dysuria.

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