Urine microscopy is also very important, we can actually see white blood cells called pyuria which indicates an inflammation or infection. Occasionally if somebody has pyelonephritis or upper urinary tract infection then we can see a white blood cell cast red blood cells or hematuria may be present with significant inflammation particularly of the bladder epithelium and of course we want to get that urine culture that will give us the definitive diagnosis with the ideologic agent so growth of 10 to the fifth or more colony forming units per millimeter of a uropathogen would be positive so once we’ve made the diagnosis of uti in our patients, we want to start treatment…. now there’s a couple of different considerations in treatment if our patients are healthy, they have a lower urinary tract infection we can do, outpatient treatment and that’s going to consist of a three to seven day antibiotic regimen for e coli and other common gram-negative bacteria. We can use antibiotics like trimethoprim, sulfamethoxazole, nitrofurantoen or phosphomycin.
We do want to be cognizant of avoiding routine use of broader agents like fluoroquinolones, we certainly don’t want to generate multi-drug resistant organisms, staph saprophyticis gets the same treatment as above with trimethoprim nitrofurantone or phosphomycin enterococcal, species however require different antibiotics with coverage for enterococcus and that’s going to include amoxicillin or amoxicillin clavulanic acid for complicated utis or patients who are going to be impatient for treatment who want a 10 to 14 day antibiotic regimen and at this point a urine culture with antimicrobial sensitivities is going to be critical in order to successfully treat that underlying urinary tract infection.