Pregnancy + UTI :
asymptomatic bacteriuria and simple cystitis 孕婦無症狀菌尿要治療
Amoxicillin 500 mg PO two to three times daily for 3 to 7 days
or cephalexin 500 mg two to four times daily for 3 to 7 days
Do not use fluoroquinolones and tetracyclines
Trimethoprim-sulfamethoxazole is not a good choice in pregnancy
can be used after the first trimester but not during the third trimester
Asymptomatic UTI 需抗生素治療：
Pregnancy and any urologic procedure with bleeding
HIV + UTI :
Fluoroquinolones should be the initial antibiotic used
Most UTIs in HIV/AIDS patients are caused by typical pathogens or common STD
TB is an infrequent cause
Urine nitrite reaction :
low sensitivity (~50%), high specificity (>90%)
Bacteria that convert nitrates to nitrite, primarily the coliform bacteria,
including E. coli.
Enterococcus, Pseudomonas, and Acinetobacter species
do not convert nitrates to nitrites in the urine
and therefore are not detected by the nitrite test.
Leukocyte esterase urine dipstick test
sensitivity of 62% to 98% and a specificity of 55% to 96%
A positive urinary dipstick nitrite or leukocyte esterase test result supports the diagnosis of UTI,
but a negative test result does not exclude it in the correct clinical presentation.
Urine leukocyte esterase AND nitrate (-), 可排除感染, UTI NPV 88%
Urine leukocyte esterase AND nitrate (+), bacteriuria sensitivity 48%, specificity 93%
單只有 leukocyte esterase (+), 不能就直接診斷 UTI
The presence of any bacteria on a Gram-stained specimen of uncentrifuged urine
(>1 bacterium/HPF or 1000×)
is significant and highly correlates with culture results of >105 CFU/mL.
女性尿液的清澈度, 對診斷 UTI 沒有幫助
與病患的 hydration status and concentration of urea in the urine 有關
UTI 不是 laboratory - defined diagnosis
尿液有 bacteria or pyuria, 病人沒有症狀, 不代表 UTI
可以是 Contamination or Asymptomatic UTI
長期尿管病患，尿液有 bacteria or pyuria
須配合感染症狀 (fever, leukocytosis, suprapubic pain, and tenderness) 給抗生素
尿管病患 candiduria 很常見
除非是 systemic candidiasis 高風險病患, 一般不需治療
Cadiduria 很難確定是感染或是 clonization
治療 indication : 有症狀, Neutropenia, 接受泌尿手術, 腎移植
治療 : 移除導尿管, 口服 fluconazole, Amphotericine B 膀胱沖洗
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