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Content: Unusual pathogens
Ureaplasma urealyticum and Mycoplasma genitalium and M. hominus - roles not completely defined
Adenovirus causes hemorrhagic cystitis in children and young adults
Candida albicans commonly causes UTI in catheterized patients in ICU
M. tuberculosis: Clinical setting → culture (-), pyuria, acidic urine, with abnormalities in UT
Diagnosis and Treatment: tailored to
Host (history)
Nature & site of infection 
Local patterns of antimicrobial susceptibility
Diagnosis: Establishment of pyuria
Wet mount of spun urine  Look for→ 8 WBC's per mm3
Urine Leukocyte Esterase Sticks
Diagnosis: Establishment of bacteriuria
Gram stain of un-centrifuged urine
Urine Nitrite Sticks test for reduction of nitrate to nitrite (Note: Detects GNB, but not all uropathogens can do this (ex. S. saprophyticus and Enterococcus)
Culturing
Culture and antibiotic sensitivity testing important for complicated infections to be sure of eradication
Escherichia coli - cause of UTI
Most common agent of all UTI's 
Predominate species of GNB in the colonic flora
Escherichia coli: virulence
Virulence of Uropathogenic Strains (UPEC)
- Type 1 fimbriae (cystitis), P fimbriae (pyelonephritis)
- hemolysins, aerobactin (siderophore)
- Resistance to serum killing, capsule, IBC formation
- Antibiotic resistance a problem (MDR GNB; ESBL)
Escherichia coli: dipsticks
Urine dipsticks positive for nitrites, Gram (-) rod, lactose (+), indole (+), oxidase (-)
Staphylococcus saprophyticus
*Causes 5-15% of community acquired UTI's in newly sexually active women ("honeymoon cystitis")*
Infection usually symptomatic
*Always nitrate negative* on urine dipsticks, low CFU's on culture, sensitive to antibiotics
Proteus mirabilis - UTIs
GI tract of mammals
Urinary tract most common site of infection.