Urinalysis Interpretation in Urinary Tract Infections (UTIs)
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- Опубликовано: 10 июл 2024
- Learn to interpret dipstick urinalysis and other tests to diagnose urinary tract infections (UTIs). How do we detect bacteria and leukocytes in urine? What else is necessary to diagnose a UTI? How reliable are our diagnostic tests, and what can throw them off? Common problems like urine sample contamination and asymptomatic bacteriuria and leukocyturia make a clinician's job difficult. It's no wonder that misinterpretation of urinalysis and misdiagnosis of urinary tract infections are important drivers of antibiotic misuse worldwide. This video will help you diagnose urinary tract infections and avoid the most common pitfalls in urinalysis.
Lecture summary in PDF:
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If you want to learn how to recognize life-threatening infections like sepsis and CNS infections as early as possible, I highly recommend you take my free online course!
A Clinical Approach to Serious Infections in Adults: What Every Physician Should Know:
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DISCLAIMER: Please, always keep in mind that my videos are intended for educational purposes only. The content of my videos is NOT medical advice. I do not practice medicine over the internet. If you are a patient and have any questions about your health, please talk to your doctor.
CHAPTERS:
00:00 Urine test strips (urine dipsticks)
00:24 Nitrite in urine
02:45 Leukocyte esterase and leukocyturia
04:20 Microscopic examination or urine sediment, hemocytometry
05:16 How to collect a urine sample and avoid contamination
08:13 Signs of sample contamination
09:28 Significant bacteriuria
11:17 Asymptomatic bacteriuria vs. UTI
REFERENCES & RECOMMENDED READING:
1. Advani SD, Polage CR, Fakih MG. Deconstructing the urinalysis: A novel approach to diagnostic and antimicrobial stewardship. Antimicrob Steward Healthc Epidemiol. 2021;1(1):e6.
2. Wilson ML, Gaido L. Laboratory Diagnosis of Urinary Tract Infections in Adult Patients. Clinical Infectious Diseases. 2004 Apr 15;38(8):1150-8.
3. Pallin DJ, Ronan C, Montazeri K, Wai K, Gold A, Parmar S, et al. Urinalysis in acute care of adults: pitfalls in testing and interpreting results. Open Forum Infect Dis. 2014 Mar;1(1):ofu019.
4. Rowe TA, Juthani-Mehta M. Diagnosis and Management of Urinary Tract Infection in Older Adults. Infect Dis Clin North Am. 2014 Mar;28(1):75-89.
5. Lifshitz E, Kramer L. Outpatient urine culture: does collection technique matter? Arch Intern Med. 2000 Sep 11;160(16):2537-40.
6. Johnson JR, Drekonja DM. Bacteriuria/Pyuria of Clinically Undetermined Significance (BPCUS): Common, but Currently Nameless. The American Journal of Medicine. 2017 May 1;130(5):e201-4.
7. McMurdo M. Commentary. Urinary tract infection in old age: over-diagnosed and over-treated. Age and Ageing. 2000 Jul 1;29(4):297-8.
I want to remind everyone that my videos are for educational purposes only. Of course, everyone is welcome to watch, but the information I present is most useful for junior doctors, nurses, and students. As I stated in the description of every video and on my channel homepage, none of this is medical advice for patients. I don't practice medicine over the internet. If you are a patient and have any questions about your health, please get in touch with your doctor.
Wonderful video!
wow very concise
Welldone brilliant✌
Well explanation
Just found out your channel and I love the content! Subscribed!
Thanks so much *MR OBALAR* on RUclips for curing me from Herpes, keep saving lives.❤
Hi ,thank you so much for your video, it's very details exactly what I needed. Please can you do videos on hcv infection and tb diagnosis /management( ordering medications) thank you
Thanks so much *MR OBALAR* on RUclips for curing me from Herpes, keep saving lives.❤
I am loving your channel and lectures. how do you differentiate CAUTI from UTI on a new admitted patient? what is practical working definition for CAUTI? I cannot get a straight forward answer
Could you please rephrase the question? I'm not sure I understood it correctly. If the patient has a urinary catheter in place and then gets a UTI, this is a CAUTI. There is no minimum period of time that the catheter must be in place in order for the UTI to be considered catheter-associated.
Thanks so much *MR OBALAR* on RUclips for curing me from Herpes, keep saving lives.❤
Can klebsiella aerogenes uti
hi, i really like your channel
i was wondering if you could make a video or reply to my comment about if one should treat fever or not both in adults and children (if so what dose of acetaminophen would you give), because it is conflicting info by doctors about it needs to run its course to increase immune system to fight off the infection. So would you give antipyretics?
Also about why some infections doesnt cause fever and why some infections cause fever
thank you, im a medical student very interested in infectious diseases
Sure, I can make a video on the pathophysiology of fever and the effect of antipyretics. Thanks for the suggestion!
Thanks so much *MR OBALAR* on RUclips for curing me from Herpes, keep saving lives.❤
I was detected kleibsella 14 days antibiotics with nitrofuratoin again disconfort ,fucked up my life 😢
Thanks so much *MR OBALAR* on RUclips for curing me from Herpes, keep saving lives.❤
8:20 what is your threshold of number of epithelial cells to favor contamination? awesome channel keep it up!
It's usually expressed in a descriptive or semi-quantitative manner (for example, a high number of epithelial cells)
Thanks so much *MR OBALAR* on RUclips for curing me from Herpes, keep saving lives.❤
our hospital will not reflex to urine culture until wbc >10/hpf despite positive nitrite or leukocyte esterase...
Thanks so much *MR OBALAR* on RUclips for curing me from Herpes, keep saving lives.❤
11:53 symptoms + UA findings concerning for UTI. this scenario can be tricky esp for elderly demented, non verbal, unresponsive patients to elicit history. maybe if there have altered mental status + UA findings go ahead with empiric?
That is a good question and a very common problem! If the cause of the patient's altered level of consciousness really is a UTI, this means that there is a significant systemic inflammatory response to this UTI, and there should be more signs of it (fever, high CRP, signs of sepsis, maybe)... If none of this is present, I would be very careful about attributing encephalopathy to bacteriuria/pyuria. Even if there are signs of SIRS/sepsis, OK, this might be urosepsis, but I would still quickly check for other potential sources of sepsis to avoid the trap of premature closure precisely because bacteriuria is so common in this age group. I explain this in detail in my video 'UTI in the Elderly'. Feel free to watch!
@@clinicaltips8926 lol unfortunately good luck explaining it to patients helicopter family this as they already have their minds made up and convinced its uti sometimes
Thanks so much *MR OBALAR* on RUclips for curing me from Herpes, keep saving lives.❤
My leukocytes keep coming back positive but nitrates keep coming back negative. The leukocytes on my test doesn't look like they are much. This indicate something serious?
Thanks so much *MR OBALAR* on RUclips for curing me from Herpes, keep saving lives.❤
It’s a gram positive infection
Can Klebsiella Pneumoniae be an UTI, and can it he sexually transmitted.
Yes, K.pneumoniae can cause UTIs. UTIs are not sexually transmitted diseases, but intercourse can increase the risk of bacteria entering the urinary tract and causing infection.
@@clinicaltips8926 how long antibiotics to treat it
@@clinicaltips8926 is klebsiella pneumoniae asymptomatic bacteriuria ? Because in my urine culture test there is klebsiella and my urologist is saying it is not causing the uti symptoms because it is asymptomatic bacteriuria
and my urologist diagnosed me with weak bladder and prescribed me urief 4mg and ucholine which i am taking it for 4 months now. is it possible to get rid of klebsiella without antibiotics ? I have urgency and frequent urination btw
Thanks so much *MR OBALAR* on RUclips for curing me from Herpes, keep saving lives.❤