Gram negative bacilli. Escherichia coli Gram positive cocci in chains. Enterococcus faecalis Gram positive cocci Staphylococcus saprophyticus Gram positive budding yeasts and large pseudohyphae. Candida albicans
False bacteriuria should be excluded
Urine samples were contaminated by leucorrhea, etc.
Urine sample was put at room temperature for more than 1 hr before inoculated.
Technical errors .
False negative in Urine culture
Use of antibiotics 7 days before culture.
Frequency: Urine stayed in the bladder for less than 6 hours;
Water diuresis or recent voiding
Disinfectant contaminating into urine sample
Anaerobe ， chlamydia ， fungi or other microorganism infection.
Recurrent UTIs ， complicated UTIs （ stone ）， Recurrent pyelonephritis ， unusual bacteria infections ， a history of UTI in pregnancy ， a history of childhood infections ， Male with UTI ， Painless hematuria
For asymptomatic pts, urine cultures should be done twice, Each time colony counts ≥10 5 CFU ／ ml with same bacteria.
G+ colony counts ≥ 10 3 CFU /ml
UTI upper UTI acute pyelonephritis
Symptoms and signs, pathogenic bacteria, tubule function and leukocyte cast
Systemic toxic symptoms ： T >38℃ ， WBC ， costovertebral angle tenderness/sensitive to percussion
Recurrent within 4 weeks after ending the treatment
Complicated with obstruction or malformation, etc
Unusual bacteria: Bacillus proteus
IVP showing abnormal image .
Review of 3 days therapy No symptoms , pyuria, bacteriuria Noninfectious Urethral syndrome Without bacteriuira With symptoms Without symptoms Yes No Without bacteriuira With bacteriuira Woman with urethral stimulate symptom 3 days antibiotics therapy （ TMP-SMZ 2 # Bid / Ofloxacin 0.2g Bid ） Urinalysis and urine bacteria culture Cystitis (cured) Symptoms relapse with pyuria and bacteriuria pyelonephritis (occult ) pyuira pyelonephritis Urethral syndrome caused by chlamydia trachomatis 7 days later 1W~1M
Systemic infection Diseases
chronic pyelonephritis: pyelography or ultrasonic examination
Cortex scars and kidney pelvis /calices deformed
Renal size: asymmetric
The following Conditions should be suspected :
Chronic urethral stimulate symptoms
Useless of antibiotics therapy
Urine bacteria culture negative
Evidence of extrarenal tuberculosis: Epididymis, spermatic cord or prostate tuberculosis
Confirmed diagnosis ：
(any one of the following three conditions can make a diagnosis ）
Review of 3 days therapy No symptoms , pyuria, bacteriuria Without symptoms Urinalysis and urine bacteria culture Cystitis (cured) 7 days later
Acute uncomplicated pyelonephritis
14 days course
Empirical treatment: Fluoroquinolone, the third generation cephalosporin or aminoglycoside
Sensitive to G- Bact. (E coli)
Less nephrotoxicity and side effects
High concentration in renal and urine.
Intravenously the first few days, taking orally 72 hrs after fever relieving .
Acute uncomplicated pyelonephritis 14 days antibiotics course Acute uncomplicated pyelonephritis Follow up at the 2 nd wk and 6 th wks Failure within 72 hr relapse Relief from symptoms without bacteriuria Cured
Change ABs :
according to drug sensitive test
6 wks’ ABs therapy
unrecognized suppurative foci
Bacteriuria reoccurs after cessation of treatment.
Reinfection : Cause by a different pathogen, usually occur 6 weeks after drug discontinuance . Cystitis
Relapse : the same strain, <2 wks, pyelonephritis
About 80% of the recurrent UTIs are reinfection.
A short-term antibiotics therapy initially.
Follow-up: 1 or 2 wks after cessation therapy.
Relief without symptoms ,bacteriuia and pyuria: Reinfection is indicated. The previous treatment was effective.
Failure to therapy :
Antibiotic-resistant : change to a sensitive ABs for a 7 days therapy
Judgments the results of treatment
Judgments after therapy with a sensitive ABs for a 7 days therapy :
If the antibiotic works well: Reinfection
If the antibiotic does not work: Relapse , same strain infection
Prolong treatment to 6 wks. If failed, prolong the course.
Check the predisposing factors
Recurrent frequently （ 2 times in half a year or 3 times in 1 year)