Urinary Tract Infection

Lana Amerie, OMS-II

 CC: “Pain and burning with Urination”
HPI: L.M is a 29 year old female comes to into
your clinic complaining of unusually frequent
urination, pain and burning sensation when she
urinates that has been occurring for the last 2
days. She is a high school teacher and she had to
Chief use the restroom 3x in an 1hr during a meeting
and 2x when she was teaching an 1hr class. Her
Complain & urine is cloudy with foul odor. She has not seen
any blood in her urine. She has never had
HPI anything like this before.
She denies having a fever, N/V, flank pain,
vaginal irritation. She is sexually active, and has
been in a monogamous relationship with her
partner for 6 years.
 Adulthood Illnesses: Exercise Induce Asthma, but
no chronic illnesses
- Last OB/GYN appointment was 2 months ago,
negative for STDs, Chlamydia, HIV and
Gonorrhea
Childhood Illnesses: Chicken pox
Surgeries: C-Section 2 years ago
Past Medical Family History: she was adopted, has 2yr old
healthy son
History Medications: Albuterol
OTC: Fish oil, B12, Kava tea (helps her relax)
Allergies: Eggs
Immunizations: all childhood immunizations are
up to date, recently got a flu shot and completed 3
doses of HPV
 Social History:
- Married for 6 years
- High school teacher
- Drinks 1 glass of wine every other night
- Doesn’t smoke cigarettes, but does smoke
marijuana occasionally
Review of Systems:
Past Medical - Resp: No cough, SOB only when excercising
History - GI: mild pain, denies nausea and vomiting
- General: No generalized weakness or changes in
weight
- GU:
 Physical Examination
• Vital Signs: BP 106/67, HR 102, RR: 16, T: 98.7
- Wt: 136.5, Ht: 5’2 BMI: 24.9
• General Impression: Alert, oriented, cooperative
• Cardiovascular Exam: No Murmurs, No extra heart sounds, No JVP, normal
Point of Maximal impulse
• Pulmonary Exam: Breath sounds are clear & normal
• Abdominal Exam: soft & non tender to touch, normal bowel sounds
• Urogenital Exam: No costovertebral angle, mild tenderness in Suprapubic
 - Dipstick Urine analysis: Urease + , WBC,
RBC
- Coagulase test: + result w/ rapid
agglutination
- Urine Culture: no growth on McConkey
plate, + growth on Novobiocin disk on
Diagnostics pheylethyl alcohol agar, gram + cocci
- Pregnancy test: negative
- Imaging?: not necessary
- Special Diagnostic test? Not necessary
 - Overactive Bladder
Differential - Pyelonephritis
Diagnosis - UTI
 Diagnosis à UTI: made based on CC, HPI,
dipstick UA, culture (Staphyloccus
Saphrophticus) and PE
Why not OAB and Pyelonephritis?
- Pyelonephritis: ruled out because patient did
not have symptoms related to Upper UTI
Differential such as fever, flank pain, nausea, and
Diagnosis vomiting
Explanation - Overactive Bladder: ruled out because urine
culture shows Staphylococcus Saphrophticus
growth
 Common Symptoms
of UTI
Bladder infection (Cystitis):
Hematuria, increased frequency,
urgency, pain, WBC in urine
Kidney Infection: Cystitis + Fever +
Lower flank Pain
 - Treat it Empirically with Fosfomycin: single
3g dose for Uncomplicated UTI
- Advise her to drink tons of water
- Educate her to wipe from front to back
Treatment/ - Educate her to urinate after intercourse
Plan - Ask the patient to comeback if UTI doesn’t
resolve within few days
- E.coli main cause of complicated and
Uncomplicated UTIs
- Staphylococcus Saprophyticus: in sexually
active women, its is the 2nd leading cause of
UTI
- In infants, having a UTI increases risk for
renal scarring à complications in adulthood
including hypertension, proteinuria, renal
damage and even chronic renal failure à
Dialysis Treatment
 References
• Lectures
• Cohn, E. and Schaeffer, A. (2004). Urinary Tract Infections in Adults. The
Scientific World JOURNAL, 4, pp.76-88.
• Tan, C. and Chlebicki, M. (2016). Urinary tract infections in adults. Singapore
Medical Journal, 57(09), pp.485-490.