1: Urinary Tract Infection Flashcards
10^2- 10^4 CPU per mL would indicate infection if…
- sample is taken by suprapubic aspiration
- sample is drawn from renal pelvis or ureter
- sample is drawn using an indwelling catheter
Significant bacteriuria
10^5 colony forming units (CFU) per mL
from a midstream urine sample “clean catch”
Acute sx UTI and asymptomatic bacteriuria for >50yrs men
due to BPH
Classification of UTI- UpperUT
- Pyelonephritis
- Perinephric abscess
Classification of UTI- LowerUT
- Cystitis
- Urethritis
- Prostatitis
- Epididymitis
Post-menopausal Recurrent UTI
- Decreased colonization with Lactobacilli
- Changes in vaginal pH
- Vaginal colonization with E. coli
Asymptomatic bacteriuria in adults- dx
Dx can be made by 2 successive urine cultures showing >10^5 CFU per mL
Indication for use of antibiotics in Asymptomatic bacteriuria in adults
- Pregnancy
- Urologic surgery
- Immunosupression
Asx Bacteriuria in Pregnancy
- Short term therapy (7 days)
- Increase risk of pyelonephritis and spontaneous abortion
Asx bacteriuria in Pregnancy- tx
- 2nd Gen cephalosorins: Cephalexin, Cefuroxime
- Sulphonamides: caution in late pregnancy-> cause kernicterus in the newborn
- Avoid fluoroquinolones and aminoglycosides during pregnancy
- Tx pyelonephritis for 14 days and test of cure is necessary (Urinalysis)
Lower UTI manifestations
- Frequency
- Dysuria
- Urgency
- Suprapubic pain/ Incontinence
Urine culture
Not routinely indicated
indicated in diabetics, recurrent UTI, use of contraceptive diaphragm, age over 65 yrs.
-for pts who are indicated for urine culture, normal tx should be extended for 7 days**
Urinalysis
Pyuria: positive leukocyte esterase test
Nitrite
Bacteriuria
Acute uncomplicated cystitis in Women- tx
- Nitrofurantoin (5days) or TMP/SMX (3days)- DOC*
- Cotrimoxazole
- Fluoroquinolones
UTI in Children- dx
for First Timers, all -Urinalysis -Urine culture -U/S should be done
UTI in Children- complication
- Renal scarring in those 3yrs old
- HTN and Renal failure occur later in life
- Even a single documented UTI in child must be taken seriously**
Urine culture for children
-in all male pts <2yrs
who has a temp of 39C (102.2F) or higher**
U/S
Used to rule out obstructive uropathy
Voiding cystogram
Initial method of choice of Vesico-Ureteral reflux
Renal nuclear scan
Best for detecting renal scarring
UTI in children- tx
Outpts
-TMP/SMX: DOC**
-Amoxicillin, Cephalosporin, Carbenicillin
Inpts
-Cephalosporin, Amoxicillin, Aminoglycoside
Treat vesicoureteral reflux with ureteral reimplantation
Prevention of Catheter asso UTI
- Catheterize for short duration (<2 weeks)
- Closed sterile collecting system
- Use of pre-connected catheter-drainage tube units
Upper UTI- sx
- High fever**, sudden onset
- Pain below the ribs**
- Tenderness at renal angles on deep palpation
**Urinary sx may be ABSENT*
Pyelonephritis- tx
- Cotrimoxazole
- Fluoloquinolone
- tx for 10-14 days
Recurrent (>3 episodes per year)- tx
Long term maintenance therapy with
Low dose Cotrimoxazole
Complicated UTI- tx
- 7day tx
- Ampicillin/ Gentamycin or
- Fluoloquinolone or
- Imipenem
Acute Prostatitis- sx
- Less than 2 months
- Perineal pain**
- Tender prostate** on DRE
- Prostatic massage may cause pus exudation
Acute prostatitis- tx
- TMP/SMX (Cotrimoxazole)
- Quinolones
Acute prostatitis- lab
Urine culture before and after prostate massage
Chronic prostatitis- sx
- Perineal/ Low back pain
- Firm, enlarged prostate on DRE
Epididymitis- Ddx
- fever, gradual onset, Pyuria, warmth
Prehn’s sign: elevating the scrotum relieves pain of Epididymitis**
Testicular torsion: sudden onset, elevation of testis
Epididymitis- tx
Bed rest for 1-3 weeks
Scrotal elevation
