Definitions

• Bacteriuria: Bacteria (any) present in urine
• Pyuria: >10 WBCs / mm3. DDx:
  • Other infections:
    • LRTI
    • Sepsis
    • Gonorrhoea/NGU
    • Vaginitis
    • Renal TB
  • Noninfective
    • Renal papillary necrosis
    • Diabetes
    • Renal stones
    • RCC
• Sterile pyuria:
  • Prior Abx Rx
  • Catheterisation
  • Stones
  • Cancer
  • STIs
  • Renal TB
  • Interstitial nephritis (NSAIDs, penicillins, aspirin, PPIs)

Epidemiology

• Women: 15% will have once
• Asymptomatic bacteriuria prevalence:
  • Women >80: 20%
  • Men >80: 10%
  • Pregnant: 4%
  • Diabetes: women higher rates compared to nondiabetic women; men no difference

Risk factors

• Abnormal UT
• Immunosuppressed: Incidence no different, except:
  • Renal transplant
  • Diabetic
• Post-renal transplant (early)
• Catheterisation

Organisms:

• Uncomplicated UTI
  • 77% E.coli
  • Other: Klebsiella spp, Proteus mirabilis
• Complicated UTI:
  • Klebsiella
  • Enterobacter
  • Proteus spp
  • Enterococcus (RF: catheter, instrumentation)
  • Pseudomonas (RF: catheter, abnormal Structure)
• Gram positives
  • 4% Staph saprophyticus
  • Streptococci: normally GBS
  • Enterococci