Bacterial Cystitis, Acute, Uncomplicated

Michael Melia, M.D.
Bacterial Cystitis, Acute, Uncomplicated is a topic covered in the Johns Hopkins ABX Guide.

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PATHOGENS

  • Uncomplicated UTI: >95% of these infections are due to single organism.
  • Culprit pathogens:
    • E. coli (75-95%)
      • Uropathogenic E. coli (UPEC) most likely to cause UTIs are groups B2 and D that have "fitness elements" providing them with advantage in extraintestinal niche.
    • Other Enterobacteriaceae (e.g., K. pneumoniae, P. mirabilis)
    • S. saprophyticus 
    • Uncommon pathogens: P. aeruginosa, Group D Streptococci
    • Rare pathogens: H. influenzae, M. tuberculosis, anaerobes, Salmonella, Shigella, adenovirus type 11, Ureaplasma, Mycoplasma, Enterococcus spp., Group B Streptococci
      • Enterococcus spp. and group B Streptococcus alone rarely cause uncomplicated cystitis (see excellent Hooton NEJM 2013 reference[3]).
        • These two organisms are recovered from midstream urine specimens of ~10% of women with cystitis, but are rarely (1%) also isolated from paired catheter urine specimens.

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PATHOGENS

  • Uncomplicated UTI: >95% of these infections are due to single organism.
  • Culprit pathogens:
    • E. coli (75-95%)
      • Uropathogenic E. coli (UPEC) most likely to cause UTIs are groups B2 and D that have "fitness elements" providing them with advantage in extraintestinal niche.
    • Other Enterobacteriaceae (e.g., K. pneumoniae, P. mirabilis)
    • S. saprophyticus 
    • Uncommon pathogens: P. aeruginosa, Group D Streptococci
    • Rare pathogens: H. influenzae, M. tuberculosis, anaerobes, Salmonella, Shigella, adenovirus type 11, Ureaplasma, Mycoplasma, Enterococcus spp., Group B Streptococci
      • Enterococcus spp. and group B Streptococcus alone rarely cause uncomplicated cystitis (see excellent Hooton NEJM 2013 reference[3]).
        • These two organisms are recovered from midstream urine specimens of ~10% of women with cystitis, but are rarely (1%) also isolated from paired catheter urine specimens.

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