Important points

1. In patients less than 5 years old, UTI is a cause for concern because it may be the presenting symptom of a genitourinary malformation. The most common examples are vesicoureteral reflux (VUR) and posterior urethral valves. Get an ultrasound and a voiding cystourethrogram to evaluate any male under 6 with a UTI and any female under 6 with recurrent U'Tls or pyelonephritis.

2. Some women get recurrent UTIs related to sex and can be given antibiotics to take afterwards.

3. Conditions that promote urinary stasis (BPH, pregnancy, stones, neurogenic: bladder, VUR) or bacterial colonization (indwelling catheter, fecal incontinence, surgical instrumentation) predispose to UTI. They also predispose to ascending UTI (pyelonephritis) and bacteremia/sepsis.

4. Asymptomatic bacteriuria is treated in pregnancy (high risk of progression to pyelonephritis).

Pyelonephritis: almost always from an ascending UTI and due to E. coli (> 80% of cases). Patients present with high fever, shaking chills, costovertebral angle tenderness/flank pain, and/or UTI symptoms. Urinalysis and urine and blood cultures establish the diagnosis.Treat on an inpatient basis with IV antibiotics while awaiting test: results (penicillin or cephalosporin plus aminoglycoside).

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