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The Rational Clinical Examination
David L. Simel, Drummond Rennie
Urinary Tract Infection, Women
Stephen Bent, Brahmajee K. Nallamothu, David L. Simel, Stephan D. Fihn, Sanjay Saint
Several types of UTI are described by their location: urethritis, cystitis, pyelonephritis, and...


Topics Discussed: diagnosis, differential, diagnostic process, pyelonephritis, urinary tract infection, women's health

Excerpt: "Acute uncomplicated UTIs are common in women, accounting for more than 7 million office visits annually in the United States1 and affecting half of all women at least once during their lifetimes.2 A recent study of sexually active young women found the incidence of cystitis to be 0.5% to 0.7% per year.3 In aggregate, the direct costs of these infections have been estimated to be $1.6 billion annually in the United States.4Several types of UTI are described by their location: urethritis, cystitis, pyelonephritis, and perinephric abscess. The usual reference standard for diagnosing UTI is the presence of "significant" bacteria in a clean-catch or catheterized urine specimen, most commonly defined as the isolation of at least 105 colony-forming units (CFU) per milliliter of a single uropathogen.2 In women who present with symptoms of cystitis or urethritis (lower UTI), it has been suggested that the best diagnostic criterion for clean-catch urine is the isolation of uropathogens in concentrations as low as at least 102 CFU/mL.9..."
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