With Money at Risk, Hospitals Push Staff to Wash Hands

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Cystitis

Cystitis is a bladder infection. It is common in women, in whom uncomplicated cystitis is usually preceded by sexual intercourse (honeymoon cystitis). In men, bacterial bladder infection is usually complicated and usually due to an ascending infection from the urethra or prostate or secondary to a urethral instrumental maneuver. The most frequent cause of recurrent cystitis in men is chronic bacterial prostatitis.

Acute urethral syndrome

Acute urethral syndrome, which occurs in women, is a syndrome involving dysuria, frequency and pyuria (dysuria-pyuria syndrome) and therefore resembles cystitis. In acute urethral syndrome (unlike cystitis), however, urine cultures are negative or have a lower bacterial count than the traditional one to diagnose bacterial cystitis.

Urethritis is a possible cause because the organisms responsible for causing it including Chlamydia trachomatis and Ureaplasma urealyticum are not detected in routine urine cultures.

Non-infectious causes have been proposed, but there are currently no conclusive elements to support the evidence, and non-infectious causes generally have a modest or absence of pyuria. Possible non-infectious causes include anatomic abnormalities (eg, urethral stricture), physiologic abnormalities (eg, pelvic floor muscle dysfunction), hormonal imbalances (eg, atrophic urethritis), localized trauma, symptoms gastrointestinal and inflammations.

Asymptomatic bacteriuria

Asymptomatic bacteriuria is the absence of signs or symptoms of urinary tract infection in a patient whose urine culture meets the criteria for urinary tract infection. Pyuria may or may not be present. Because it is asymptomatic, such bacteriuria is found mainly when screening in high-risk patients or when urine culture is done for other reasons.

Screening for asymptomatic bacteriuria is indicated in people at risk of complications if bacteriuria is not treated. Such patients include

Pregnant women 12 to 16 weeks’ gestation or at the first antenatal visit, whichever is later (due to the risk of symptomatic UTI, including pyelonephritis, during pregnancy; and due to negative pregnancy outcomes, including newborn with low birth weight and preterm delivery; see the US Preventive Services Task Force Reaffirmation Recommendation Statement.)

Patients who have had a kidney transplant within the previous 6 months

Young children with macroscopic vesicoureteral reflux

Patients who have had a kidney transplant within the previous 6 monthsBefore some invasive urogenital tract procedures that can cause mucosal bleeding (eg, transurethral resection of the prostate) Some patients (eg, postmenopausal women, patients with controlled diabetes, patients with foreign bodies such as stents, nephrostomy tubes, and indwelling catheters) often have persistent asymptomatic bacteriuria and sometimes pyuria.

  1. If they are asymptomatic, these patients should not be screened periodically because they are at low risk.
  2. In patients with indwelling catheters, treatment of asymptomatic bacteriuria often fails to eliminate bacteriuria and only leads to the development of antibiotic-resistant microorganisms.

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