101. Urinary Tract Infection (16%) / Dysuria (1%) Flashcards
Lorsqu’un diagnostic d’infection urinaire non compliquée est posé, est-ce qu’il faut attendre la cultre avabt de tx ?
Non
traitez le patient rapidement sans attendre le résultat de la culture
Dans des cas de dysurie, pensez à des étiologies liées à une infection non urinaire.
Nommez en (4)
- prostatite
- vaginite
- maladie transmise sexuellement
- irritations chimiques
Lors de l’évaluation des patients atteints de dysurie, nommez les personnes qui présentent un risque plus élevé d’infection urinaire compliquée
- femmes enceintes
- enfants
- diabète
- urolithiase
Chez les patients souffrant de dysurie récurrente, cherchez une cause sous-jacente précise. Nommez des exemples.
- infection urinaire postcoïtale
- vaginite atrophique
- rétention
Nommez des complications sérieuses résultant d’une infection urinaire (3)
- septicémie
- pyélonéphrite
- calculs enclavés infectés
Lorsque vous posez un diagnostic d’infection urinaire, recherchez et identifiez à l’histoire les facteurs de risque importants.
Nommez en.
- grossesse
- patient immunosupprimé
- nouveau-né
- diabétique
- jeune homme ou homme âgé avec hypertrophie de la prostate
Describe COMPLICATED UTI (4)
Complicated - risk of treatment failure
- Anatomic or functional abnormality of urinary tract (enlarged prostate, stone, diverticulum, neurogenic bladder)
- Immunocompromised host
- Multi-drug resistant bacteria
- Pyelonephritis
Describe COMPLICATED UTI (1)
Cystitis in immunocompetent nonpregnant healthy woman without anatomic/functional abnormality
Describe microbiology of UTIs
KEEPS
- Klebsiella pneumoniae
- E Coli – most common (75-95%), especially in women
- Enterococci – most common in LTC facilities
- Proteus mirabilis – most common in men
- Staph saprophyticus
Name risk factors for UTI (6)
- Age
- Female
- Neurogenic bladder/urinary incontinence, vesicoureteral reflux, posterior urethral valves, prolapse, BPH
- Indwelling catheter, recent surgery/instrumentation
- Diabetes, other comorbidities
- Sexual activity
Name DDX : Dysuria (7)
- Infectious : Cystitis, Pyelonephritis, Urethritis, Vulvovaginitis, Cervicitis, Prostatitis, epididiymo-orchitis
- Foreign body : Urolithiasis
- Dermatologic : Irritant/Contact dermatitis, lichen sclerosus, lichen planus, psoriasis, Stevens-Johnson, Behçet syndrome
- BPH, urethral stricture
- Neoplastic
- Trauma/surgery
- Interstitial cystitis (bladder pain syndrome)
Name investiations : UTI (5)
- UA if history not clear
- Urine culture indicates UTI only if accompanied by symptoms
- Labs (serum creatine, electrolytes)
- r/o STI in sexually active
- Urine color, clarity, odor cannot be used to diagnose UTI (usually due to diet and hydration status)
Describe tx asx bacteruiria
Do not treat asymptomatic bacteriuria unless pregnant or undergoing GU surgery
Describe tx : Simplye cystitis in women (3)
Nitrofurantoin
TMP-SMX DS
Fosfomycin
Describe tx : Simplye cystitis in PREGNANT women (5)
- Amoxicillin
- Amoxicillin-clavulanate
- Cefixime
- Nitrofurantoin (may want to avoid in first trimester)
- TMP-SMX avoid in first trimester and at term
Describe tx : Acute Pyelonephritis or complicated cystitis in women
- Ciprofloxacin
- Can consider initial intravenous dose: Ceftriaxone 1g IV or 24h dose of aminoglyocoside
- If complicated pyelonephritis consider inpatient IV antibiotics initially and longer 14d course
Describe tx : UTI in men (2)
- Consider r/o prostatitis, urethritis
- Fluoroquinolones (Cipro, levofloxacin)
Describe tx : UTI with Urinary Catheter (4)
- Ideally remove catheter prior to antibiotics
- Otherwise intermittent catheterization if possible
- Otherwise replace catheter after antimicrobial therapy started
- 7-14 day antimicrobial treatment generally adequate
Describe UTI prevention tips (7)
- Hydration, nutrition
- Perineal hygiene
- Healthy voiding habits
- Avoid unnecessary urinary catheters (consider intermittent cathterization). Aseptic technique for urinary catheters
- May consider cranberry prophylaxis (eg. juice or tablet)
- May consider discussing antibiotic prophylaxis (continuous x 1 year or postcoital) vs. self-treatment in recurrent UTI (eg. 2+/6mo, 3+/12mo)
- May consider vaginal estrogen therapy in peri/post-menopausal women
