Figure 74

Principal pathogens of urinary tract infection (UTI). A and B, Most pathogens responsible for UTI are enterobacteriaceae with a high predominance of Escherichia coli. This is especially true of spontaneous UTI in females (cystitis and pyelonephritis). Other strains are less common, including Proteus mirabilis and more rarely gram-positive microbes. Among the latter, Staphylococcus saprophyticus deserves special mention, as this gram-positive pathogen is responsible for 5% to 15% of such primary infections, is not detected by the leukocyte esterase dipstick, and is resistant to antimicrobial agents that are active on gram-negative rods.

C, Acute simple pyelonephritis is a common form of upper UTI in females and results from the encounter of a parasite and a host. In the absence of urologic abnormality, this renal infection is mostly due to uropathogenic strains of bacteria [5,6], a majority of cases to community-acquired E. coli. The clinical picture consists of fever, chills, renal pain, and a general discomfort. Tissue invasion is associated with a high erythrocyte sedimentation rate and C-reactive protein level well above 2 mg/dL.

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