021115 UTIs

Question 1

cystitis (bladder infec) symptoms

Answer 1

dysuria
urinary frequency
urinary urgency
suprapubic pain
cloudy/smelly urine
hematuria (not specific to UTI)

Question 2

pyelonephritis (kidney infec) symptoms

Answer 2

flank/back pain
high fever, chills
headache
nausea, vomiting
maybe septic shock
with or without cystitis symptoms

Question 3

complicated vs uncomplicated UTI

Answer 3

uncomplicated-in healthy pt with normal urinary tract

complicated-assoc w factors predisposing to bac infec and decrease efficacy of therapy

Question 4

causes of complicated UTI

Answer 4

abnormal GU tract (anatomic or functional):

• urinary obstruction (BPH, scar, stone)
• urinary stasis (incomplete bladder emptying, diverticulum)
• vesicoureteral reflux (backwashing of urine from bladder to ureters/kidneys)
• foreign body (catheter, stone)
• neurogenic bladder with high pressures (sp cord injury)

immunocompromised/unhealthy host
-diabetes, transplant pts, chronic steroids

multidrug resistant bacteria

Question 5

what can urinalysis screen for?

Answer 5

urinary blood
pus (leukocytes)
bacteria
pH
specific gravity (concentration)
protein
glucose

Question 6

what is microscopic analysis used for?

Answer 6

dipsticks (chemical strip analysis) may have false positives so micro analysis used to confirm

it’s the definite test for blood (RBC) and pus (leukocytes)

Question 7

sensitivity and specificity of leukocyte esterase in UA

Answer 7

high sensitivity for UTI

low specificity for UTI

Question 8

sensitiv and specificity of nitrites on UA

Answer 8

high specificity for UTI

low sensitivity for UTI (not all bacteria have enzyme nitrate reductase)

Question 9

uropathogens for uncomplicated UTI

Answer 9

E coli (80%)
S saprophyticus
Enterobacteriaceae
gram positive bacteria

Question 10

uropathogens for complicated UTI

Answer 10

E coli (20%)
enterobacteriaceae
other gram negatives
gram positives (S aureus, etc)
yeasts and fungi (candida)
paraistes (schitosoma haematobium)

Question 11

basic UTI evaluation

Answer 11

H and P, UA, culture and sensitivity

Question 12

when do you do adjuvant tests in addition to basic UTI eval?

Answer 12

if there’s signs of systemic illness or poor renal function (may do blood testing)

if sicker pt with a kidney infec, may consider XR if antibiotics don’t work to look for hydronephrosis, stones, abscess