Renal · Year 2 · from Renal

Case 1: Uncomplicated Cystitis

Patient Presentation

Demographics: 28-year-old female

Chief Complaint: Painful urination and urinary frequency for 2 days

History of Present Illness: The patient developed dysuria, urinary frequency, and urgency 2 days ago. She has mild suprapubic discomfort but denies flank pain, fever, nausea, or vaginal discharge. She is sexually active with a new partner and notes symptoms began shortly after intercourse. She has had one prior UTI 3 years ago.

Past Medical History:

  • No significant medical history
  • No allergies

Physical Examination:

  • Blood pressure: 118/72 mmHg
  • Temperature: 37.0C
  • General: Well-appearing, no distress
  • Abdomen: Mild suprapubic tenderness
  • CVA: No tenderness bilaterally
  • No vaginal discharge on external exam

Workup and Results

Urinalysis:

  • Leukocyte esterase: Positive
  • Nitrite: Positive
  • WBC: 50-100/hpf
  • Bacteria: Many
  • No hematuria

Clinical Image

Urinalysis demonstrating pyuria with numerous white blood cells and bacteria, consistent with acute bacterial cystitis. The positive nitrite test suggests presence of gram-negative bacteria.

Diagnosis

Uncomplicated Acute Bacterial Cystitis

Criteria met:

  • Healthy, non-pregnant woman
  • Normal urinary tract anatomy
  • Classic lower UTI symptoms
  • No fever or flank pain (excluding upper tract involvement)

Discussion

This case illustrates uncomplicated cystitis:

  • Definition: The lecture defines uncomplicated UTI as occurring in a healthy, non-pregnant woman with normal urinary tract anatomy. This patient meets all criteria.
  • Pathogenesis: The lecture describes the ascending route as the primary mechanism, with the shorter female urethra explaining the higher UTI incidence in women. Sexual activity increases risk by promoting bacterial colonization.
  • E. coli Predominance: The lecture states that Escherichia coli causes 80-90% of uncomplicated community-acquired UTIs. The positive nitrite test supports gram-negative infection.
  • No Culture Needed: For uncomplicated cystitis, empiric treatment without culture is appropriate. Cultures are reserved for complicated infections, treatment failure, or recurrence.

Treatment Plan

  1. First-line Antibiotic Options:
  • Nitrofurantoin 100 mg twice daily for 5 days (first-line)
  • OR Trimethoprim-sulfamethoxazole DS twice daily for 3 days
  • OR Fosfomycin 3 g single dose
  1. Avoid Fluoroquinolones:
  • Reserve for complicated infections due to resistance concerns
  1. Symptomatic Relief:
  • Phenazopyridine for dysuria (warn about orange urine)
  • Increased fluid intake
  1. Patient Education:
  • Void after intercourse
  • Wipe front to back
  • Complete antibiotic course

Teaching Points

  1. Uncomplicated cystitis occurs in healthy, non-pregnant women with normal anatomy
  2. E. coli causes 80-90% of uncomplicated UTIs
  3. Culture is not required for uncomplicated cystitis
  4. Nitrofurantoin or TMP-SMX are first-line treatments
  5. Fluoroquinolones should be reserved for complicated infections

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