Genitourinary Infections

• Urinary tract infections (UTIs) can be uncomplicated or complicated, depending on host factors and underlying conditions. Diagnostic and therapeutic approaches to adult genitourinary infections are determined by gender-specific anatomic differences, prior antimicrobial exposures, and the presence of catheters, stents, etc.

and K. pneumoniae) and Staphylococcus saprophyticus.

• Workup includes urinalysis and microscopic examination of a fresh, unspun, clean-voided, or catheterized urine specimen. Pyuria (positive leukocyte esterase or ≥8 leukocytes per high-power field) or bacteriuria (positive nitrites or ≥1 organism per oil immersion field) suggests active infection if compatible symptoms are present. A high number of epithelial cells indicate an inadequate sample. A urine Gram stain can be helpful in guiding initial antimicrobial choices. Quantitative culture often yields >10⁵ bacteria colony-forming units (CFU)∕mL, but colony counts as low as 10²-10⁴ bacteria/mL may indicate infection in women with acute dysuria.