Urinary tract infections

Tomado de: http://foamcast.org/

We cover Free Open Access Medical Education (FOAM) from a recent Emergency Medicine Cases podcast and First10inEM blog post by Dr. Justin Morganstern regarding urinary tract infections (UTIs). This podcast and blog tackle common issues in UTI diagnosis and treatment, including the following points:
UTI is a clinical diagnosis, a dirty urine does not mean the patient has a UTI

Urinalyses are more complicated to interpret than we probably understand

The Core Content
Rosen’s Emergency Medicine (8th ed), Chapter 99; Tintialli’s Emergency Medicine (8th ed), Chapter 91; IDSA Guidelines for Treatment and Asymptomatic Bacteriuria

Rosh Review Emergency Board Review Questions
A 6-year-old girl presents with 4 days of lower abdominal pain. The patient complains of dysuria. On exam, the patient is afebrile and has mild tenderness to palpation in the suprapubic area. No costovertebral tenderness is elicited on exam. A clean-catch urine sample is sent for urinalysis. If positive, which of the following is the most specific to confirm the diagnosis?
A. Glucose
B. Leukocyte esterase
C. Nitrites
D. WBCs (>5 per high power field)

A 24-year old woman presents with URI symptoms. She is 32 weeks pregnant. As part of her work-up, you order a urinalysis, which shows 2+ bacteria with no WBCs. Two days later, the lab calls you and informs you that the urine culture is positive. You call the patient back and she denies symptoms of urinary tract infection. With regards to the urine culture results, what treatment is indicated?
A. Cephalexin 500 mg QID for 7 days
B. Ciprofloxacin 500 mg QID for 7 days
C. No treatment is necessary
D. Trimethoprim-sulfamethoxazole 1 DS tablet BID for 3 days

Gupta K et al. International Clinical Practice Guidelines for the Treatment of Acute Uncomplicated Cystitis and Pyelonephritis in Women: A 2010 Update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Infect Dis (2011) 52 (5): e103-e120.
Nicolle L et al. Infectious Diseases Society of America Guidelines for the Diagnosis and Treatment of Asymptomatic Bacteriuria in Adults. Infect Dis (2005) 40 (5): 643-654.
Rosen’s Emergency Medicine, 8th ed. Chapter 99.
Tintinalli’s Emergency Medicine, 8th ed. Chapter 91.



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