1: Introduction
2: Epidemiology
3: Risk Factors
4: Asymptomatic Bacteriuria
5: Asymptomatic Bacteriuria: Treatment
6: Pyuria
7: Diagnosis (part 1)
8: Diagnosis (part 2)
9: Diagnosis (part 3)
10: Treatment
11: Summary
12: Quiz
1. Which of the following groups of people should be screened routinely for asymptomatic urinary tract infection?
a. Persons with chronic indwelling catheters b. Pregnant women c. Diabetics with diabetic nephropathy d. All of the above
2. Which of the following organisms, if found on urine culture, should always be treated with antibiotics?
a. Pseudomonas aeruginosa b. Proteus mirabilis c. Candida albicans d. None of the above
3. What duration of therapy (days) is appropriate for a patient with a positive urine culture for >100,000 cfu of E. coli and no symptoms?
Enter number of days:
True or False:
4. It is recommended that a post-treatment urine culture be done after completion of antibiotics for urinary tract infection in long-term care residents.
True False
5. Urinary tract infection is the most common cause of bacteremia in residents of long-term care facilities.
6. Most cases of fever without localizing symptoms in a resident of a long-term care facility without an indwelling catheter are due to urinary tract infection.
Cases:
You are called about an 80 year old male with cloudy and foul smelling urine for the past day. He has a chronic urinary catheter because of urinary retention. He has no fever, chills, or pain, and otherwise feels well. His vital signs are normal. He had a similar episode 1 month ago, which improved with antibiotics.
7. What is the most appropriate course of action?
a. Start antibiotic therapy b. Send urinalysis and urine culture now c. Replace catheter, then send urinalysis and urine culture d. Do not start antibiotics or send urinalysis or culture
You receive a phone call regarding a positive urine culture on one of your patients. Your patient is a 74 year old female who recently had left hip surgery after a fall and hip fracture. Two days ago, she developed fever to 100.5 degrees along with left leg pain. At that time, she was seen in an emergency room and diagnosed with a DVT (deep venous thrombosis). As part of her evaluation for fever, a urinalysis and urine culture was obtained. The urine culture is now growing >100,000 colonies of Klebsiella pneumoniae. The patient is currently doing well with only some mild leg pain which is improving.
8. How should this patient's positive urine culture be managed?
a. Treat her with amoxicillin for 10 days b. Treat her with levofloxacin for 14 days c. Treat her with Bactrim for 14 days d. Do not start any antibiotics
