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Urinary tract infection (UTI) encompasses a broad range of clinical entities that vary in their clinical presentation, degree of tissue invasion, epidemiologic setting, and antibiotic therapy requirements. There are 4 major types of UTIs: urethritis, cystitis, acute urethral syndrome, and pyelonephritis. UTIs may also be classified as uncomplicated or complicated. Escherichia coli is the leading cause of uncomplicated community-acquired UTI. Risk factors that predispose one to complicated UTIs include: underlying diseases that are associated with kidney infection (eg, diabetes), kidney stones, structural or functional urinary tract abnormalities, and indwelling urinary catheters. Another classification of UTIs is as upper UTI (related to the kidney, renal pelvis, or ureter) or lower UTI (urinary bladder and urethra). The classic symptoms of upper UTI are fever (often with chills) and flank pain; frequent painful urination, urgency, and dysuria are more often associated with lower UTI.
Diagnosis of urinary tract infections
Quantitative culture results may be helpful in discriminating contamination, colonization, and infection.
In general, the isolation of >100,000 cfu/mL of a urinary pathogen is indicative of urinary tract infection. Isolation of 2 or more organisms >10,000 cfu/mL may suggest specimen contamination.
Although urine is normally sterile, contamination by organisms normally present in the urethra or on periurethral surfaces can allow a proliferation of these organisms yielding misleading urine culture results.
Urine held at ambient temperature for >30 minutes supports the growth of both pathogens and contaminants, leading to potentially inaccurate colony counts.
Urine obtained from catheter bags at the bedside and Foley catheter tips are unacceptable for culture.
Identification of probable pathogens with colony count ranges
Forbes BA, Sahm DF, Weissfeld AS: Infections of the urinary tract. In Bailey and Scott’s Diagnostic Microbiology. 12th edition. St. Louis, MO, Mosby, 2007, pp 842-855