012-3-11 Clinical symptoms of Utls Diagnosis TYPE OF URINARY TRACT INFECTION TYPICAL SYMPTOMS quent voiding a Laboratory findings uming during and after voiding ■ maging Pyelonephritis Flank pains a Differetial diagnosis Cystitis symptoms(may be absent) Septic shock Urinanalysis Urine culture a Pyuria should be demonstrated in patients with acute a The ways to get the urine sample UTIs, and its absence calls the diagnosis into question a The most reliable result is obtained if the sample is ■ Tested in3ways (frequently used in infants but rarely in older children urine and counting n The second best technique is to use a leukocytes esterase stick a Sampling by bladder catheterization st, which is highly sensitive and allows a crude quantification of a 2% risk of introducing bacteria into and subsequently causing bacteriuria) midstream urine sample and is not recommended (requires the patient to be well informed about the Correct sampling procedure A nitrite test can be used for screening of bacteriuria n Men should withdraw the foreskin and women should keep the labia apart m It's a stick test that demonstrates the presence of nitrite s Washing of the genital tract before sampling is no metabolize nitrate to nitrite which can be demonstrated by a color reaction on a paper stick. m During voiding, the first and last parts of the urine should s G(+)bacteria and fungi do not metab m The technique is rapid (<1 min) and m It has a high degree of specificity but is rather insensitive After sampling, the urine should be chilled(but not frozen)2012-3-11 6 Clinical symptoms of UTIs Diagnosis „ Laboratory findings „ Imaging „ Differetial diagnosis Urinanalysis „ Pyuria should be demonstrated in patients with acute UTIs, and its absence calls the diagnosis into question. „ Tested in 3 ways: … Best done by staining uncentri Best done by staining uncentrifuged urine and counting urine and counting leukocytes in a Bϋrker chamber. … The second best technique is to use a leukocytes esterase stick test, which is highly sensitive and allows a crude quantification of pyuria. … The technique of counting leukocytes in the sediment obtained after centrifugation was once used routinely, but it is impresice and is not recommended. Urine culture „ The ways to get the urine sample: … The most reliable result is obtained if the sample is taken by suprapubic aspiration (frequentlu used in infants but rarely in older children and adults and adults) … Sampling by bladder catheterization (carries about a 2% risk of introducing bacteria into the bladder and subsequently causing bacteriuria) … To collect a midstream urine sample (requires the patient to be well informed about the sampling procedure) Correct sampling procedure „ Men should withdraw the foreskin, and women should keep the labia apart. „ Washing of the genital tract before sampling is not recommended. „ During voiding, the first and last parts of the urine should not be sampled. „ After sampling, the urine should be chilled (but not frozen) to prevent growth during transportation to the lab. A nitrite test can be used for screening of bacteriuria „ It’s a stick test that demonstrates the presence of nitrite in the urine. „ G(-) bacteria, with the exception of P. aeruginosa, metabolize nitrate to nitrite, which can be demonstrated by a color reaction on a paper stick. „ G(+) bacteria and fungi do not metabolize nitrate. „ The technique is rapid (<1 min) and inexpensive. „ It has a high degree of specificity but is rather insensitive „ It is not suitable for use in patients with recurrent infections (enterococal is common)