Title: Urinary Tract Infection (UTI) and Cystitis (Bladder Infection) in Females Workup: Approach Considerations, Urinalysis, Urine Culture
Headings: Urinary Tract Infection (UTI) and Cystitis (Bladder Infection) in Females Workup
Urinary Tract Infection (UTI) and Cystitis (Bladder Infection) in Females Workup
Approach Considerations

Content: John L Brusch, MD, FACP; Chief Editor: Michael Stuart Bronze, MD more...
Sections
Urinary Tract Infection (UTI) and Cystitis (Bladder Infection) in Females
Sections Urinary Tract Infection (UTI) and Cystitis (Bladder Infection) in Females
Overview
Practice Essentials
Background
Pathophysiology
Etiology
Epidemiology
Prognosis
Patient Education
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Presentation
History
Physical Examination
Acute Urethritis Versus Cystitis
Infection in Patients with Spinal Cord Injury
Catheter-Related Infection
Infection in Pregnant Patients
Infection in Patients with Diabetes Mellitus
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DDx
Workup
Approach Considerations
Urinalysis
Urine Culture
Complete Blood Cell Count
Diagnostic Catheterization
Patients with Spinal Cord Injury
Patients with Diabetes Mellitus
Cystitis Caused by Candida
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Treatment
Approach Considerations
Uncomplicated Cystitis in Nonpregnant Patients
Complicated Cystitis in Nonpregnant Women
Antimicrobial Therapy
Adjunctive Therapy
Fungal Infection
Treatment in Patients with Spinal Cord Injury
Pregnant Patients
Renal Transplantation Patients
Asymptomatic Bacteriuria
Diet
Consultations
Prevention and Long-Term Monitoring
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Guidelines
Medication
Medication Summary
Sulfonamides
Antibiotics, Other
Fluoroquinolones
Penicillins, Amino
Cephalosporins, Second Generation
Cephalosporins, Third Generation
Cephalosporins, Other
Penicillins, Extended-Spectrum
Aminoglycosides
Analgesics, Urinary
Carbapenems
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Questions & Answers
Media Gallery
Tables
References
Workup
Approach Considerations
In the 1980s, many experts felt that urine cultures were unnecessary in young women with probable cystitis because almost all of these were caused by pan-susceptible isolates of Escherichia coli. Since then, however, antibiotic resistance in uropathogenic E coli has become a significant concern. Resistance has also been emerging among other common cystitis pathogens, including Enterococcus faecalis, Staphylococcus saprophyticus, Klebsiella pneumoniae, and Proteus mirabilis. Trimethoprim-sulfamethoxazole (TMP-SMX) resistance has reached levels as high as 20% in some communities. Substitution of fluoroquinolones has resulted in an increase in resistance to these drugs, as well. [ 15]
Nevertheless, according to guidelines from the American College of Obstetricians and Gynecologists, a urine culture is not required for the initial treatment of women with a symptomatic lower urinary tract infection (UTI) with pyuria or bacteriuria or both. [ 16] In a United Kingdom study, dipstick diagnosis proved more cost-effective than positive midstream urine culture for targeting antibiotic therapy. [ 4]
Consider obtaining urine cultures in cases of cystitis in immunosuppressed patients and those with a recent history of instrumentation, exposure to antibiotics, or recurrent infection.