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Year 3 - Clinical > 12 - UTI > Flashcards

12 - UTI Flashcards

1
Q

What is cystitis?

A

Infection of bladder and/or ureters (lower urinary tract)

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2
Q

What are the most common pathogens in acute cystitis?

A
  • E. coli

- Staph saprophyticus (CoNS), Klebsiella spp, proteus mirabilis

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3
Q

Defences of the urinary tract

A
  • pH, osmolality, urea, organic acids
  • Epithelial glycosaminoglycan
  • IGs
  • Bacterial adherence and virulence factors
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4
Q

Risk factors for acute cystitis

A
  • Female, particularly previous UTI, sexually active, pregnant, or post-menopausal
  • Obstruction (BPH), urinary reflux, incontinence, urinary catheter
  • Diabetes, immunocompromised
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5
Q

What is the clinical presentation of acute cystitis?

A
  • 90% probability w/ 2 of dysuria, urinary frequency or urgency
  • May have suprapubic pain, mild hematuria, or cloudy urine
  • Atypical presentation on elderly (confusion, agitation, GI sx)
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6
Q

Describe differential diagnosis of acute cystitis

A
  • Pyelonephritis (fever, chills, N/V, flank pain)
  • Vaginitis (discharge, odour, pruritus)
  • Acute urethritis/STI (dysuria, no frequency or urgency)
  • PID/STI (discharge, dysuria, pelvic pain, fever)
  • Drug induced cystitis (allopurinol, cyclophosphamide, danazol)
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7
Q

Describe diagnostic testing involved in urinalysis

A
  • Microscopic > 10^5 cfu/mL
  • Chemistry (dipstick test) for nitrite, leukocyte esterase; positive nitrite and leukocyte esterase test specific for bacteriuria
  • Microscopic pyuria > 10 cells/uL
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8
Q

When are urine cultures done?

A
  • Tx failure
  • Relapse
  • Complicated infection (children, pregnancy, males)
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9
Q

What factors indicate potentially complicated acute cystitis?

A
  • Male, pregnancy, children < 16 y/o
  • Relapse
  • Urinary lesion, catheter, obstruction, neurogenic bladder
  • Immunocompromised (HIV, lymphoma, leukemia, uncontrolled diabetes, immunosuppressants)
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10
Q

What is the problem w/ dipstick tests?

A

Often produce false-negatives when gram pos or P. aeruginosa are present b/c they don’t reduce nitrate to nitrite

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11
Q

What is pyuria?

A
  • WBC greater than 10^6 per L

- Signifies inflammation and not necessarily infection

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12
Q

What is the significance of complicated acute cystitis?

A
  • Higher risk of multiple and/or antimicrobial-resistant pathogens
  • Antimicrobial therapy x 1-2 weeks (per urine culture/ susceptibilities and pt characteristics)
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13
Q

Antimicrobial options for acute uncomplicated cystitis

A
  • Nitrofurantoin 100 mg q12h x 5 days
  • TMP-SMX 160/800 (DS) q12h x 3 days
  • [Amox-clav 875/125 q12h x 7 days]
  • [Cephalexin 500 q6h / cefprozil x 7 days]
  • [Fosfomycin 3 g x 1 dose]
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14
Q

Indication of nitrofurantoin

A
  • Mild-moderate cystitis

- Not for treating systemic infections b/c concentrates in urine and doesn’t have good plasma concentrations

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15
Q

When should nitrofurantoin not be used?

A
  • Clcr < 30 mL/min
  • Pregnancy at term > 36 weeks
  • Neonates < 1 month (displaces bilirubin, which would cause or worsen jaundice in newborn/ neonate)
  • Glucose-6-phosphate dehydrogenase deficiency
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16
Q

Indication of TMP-SMX

A

Mild-moderate cystitis (E. coli, klebsiella spp, proteus spp, S. aureus)

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17
Q

When should TMP-SMX not be used?

A
  • E. coli resistance > 20%
  • Clcr < 10-15 mL/min
  • Pregnancy
  • G6PD deficiency
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18
Q

Can fluoroquinolones be used for acute uncomplicated cystitis?

A
  • Use is reserved for moderate-severe or complicated infection
  • Not recommended for children or pregnancy
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19
Q

Typical response for tx of acute uncomplicated cystitis

A
  • Urinary sx improved w/in 1 day

- Resolution w/in 3 days

20
Q

Indication of fosfomycin

A

Mild-moderate cystitis associated w/ E. coli or E. faecalis

21
Q

What is the difference between relapse and recurrence?

A
  • Relapse = re-infection w/ same organism w/in 2 weeks

- Recurrence = 2 infections w/in 6 months or 3 or more infections w/in 12 months

22
Q

What should be done for relapse of cystitis?

A
  • Urine culture to identify potentially resistant pathogen and for possible pyelonephritis
  • Re-treat as described for acute cystitis, consider longer duration
23
Q

What should be done for recurrent cystitis?

A
  • Treat as described for acute uncomplicated cystitis
  • For frequent recurrences, urine culture and work-up for underlying medical conditions
  • Prophylaxis not generally recommended
24
Q

Antimicrobial therapy for treating acute cystitis in pregnancy

A
  • Nitrofurantoin, amox-clav (amox if susceptible), or cephalexin (cefixime, cefprozil if susceptible) x 7 days
  • Urine culture and confirm tx success w/ follow-up culture
25
Q

Approach to tx of acute cystitis in children

A
  • Urine culture and confirm tx success w/ follow-up culture
  • Work-up for pyelonephritis, underlying medical condition, or anatomical anomaly
  • Amox-clav, cephalexin (cefixime if susceptible), nitro, or TMP-SMX
26
Q

Tx for pyelonephritis in children

A

Gent +/- ampicillin or ceftriaxone IV

27
Q

What is asymptomatic bacteriuria?

A

Bacteria counts of 10^5 cfu/mL or greater in urine w/o signs of infection

28
Q

Tx for asymptomatic bacteriuria

A
  • Antimicrobial therapy x 3-7 days in pregnant women and prior to traumatic urologic procedures
  • Antimicrobial therapy may be indicated for immunocompromised (not diabetes, advanced age, nursing home, spinal cord injury, or catheter)
29
Q

Why are pregnant women treated for asymptomatic bacteriuria?

A
  • Can lead to pyelonephritis

- Can transfer to infant during delivery (like group B strep in birth canal)

30
Q

What is the relevance of catheter-associated UTI?

A
  • Bacteruria rate of 3-10% per day of catheterization
  • Often polymicrobial involving atypical and MDR organisms
  • Signs of infection
31
Q

What is the tx for catheter-associated UTI?

A
  • Remove or replace catheter

- Antimicrobial therapy for at least 7 days as per culture/ susceptibilities

32
Q

Most common pathogens of pyelonephritis

A
  • E. coli

- Klebsiella spp, P. mirabilis, S. saprophyticus, S. aureus, enterococcus spp

33
Q

Risk factors for acute pyelonephritis?

A
  • Acute cystitis, previous pyelonephritis
  • Elderly, pregnancy, diabetes, immunocompromised
  • Anatomical abnormalities, neurological/ muscular disease
  • Lesions or obstructions
34
Q

What factors constitute complicated pyelonephritis?

A
  • Male, pregnancy, children < 16 y/o
  • Relapse
  • Urinary lesion, catheter, obstruction, neurogenic bladder
  • Immunocompromised (HIV, lymphoma, leukemia, uncontrolled diabetes, immunosuppressants)
  • Urosepsis (bacteremia) w/ significant signs of infection
35
Q

Clinical presentation of acute pyelonephritis?

A
  • Fever, chills, N/V, flank pain

- Leukocytosis, hypotension, tachycardia

36
Q

Antimicrobial options for mild-moderate pyelonephritis? PO or IV?

A
  • PO
  • Cipro 500-750 mg q12h or 1 g x 7 days
  • Levo 500 mg q24h x 7 days or 750 mg q24h x 5 days
  • [TMP-SMX x 7-14 days]
  • [Amox-clav x 7-14 days]
37
Q

Antimicrobial options for moderate-severe pyelonephritis? PO or IV?

A
  • PO or initial IV w/ PO step-down
  • Cipro 400 mg q12h (IV)
  • Levo 500-750 mg q24h x 7-14 days
  • TMP-SMX 160/800 q12h x 7-14 days
38
Q

Antimicrobial options for severe or hospital-acquired pyelonephritis? PO or IV?

A
  • IV
  • Gent +/- ampicillin (for enterococcus coverage)
  • Ceftriaxone
  • Pip-tazo (has enterococcus coverage)
  • Mero/ertapenem
39
Q

Response to tx for acute pyelonephritis

A
  • Clinical improvement w/in 1-2 days

- Resolution w/in 3-4 days

40
Q

Signs and sx of acute prostatitis

A

Sudden onset fever, tenderness, and urinary sx

41
Q

Most common pathogens of acute prostatitis

A

Gram-neg enteric organisms

42
Q

Tx for acute prostatitis

A
  • Good tx response
  • Cipro/ levo or TMP-SMX (per susceptibilities) x 4 weeks
  • Severe infection may require initial IV therapy
43
Q

Signs and sx of chronic prostatitis

A
  • Complication of recurrent infections

- Urinary sx including lower back pain or pressure

44
Q

Most common pathogen in chronic prostatitis

A

E. coli

45
Q

Tx for chronic prostatitis

A
  • Poor tx response b/c low antimicrobial penetration into prostatic fluid
  • Cipro/ levo or TMP-SMX for at least 4-6 weeks (per susceptibilities)
  • May also require chronic suppressive therapy or surgery

Year 3 - Clinical (30 decks)

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