130 - Urinary Tract Infection, Pyelonephritis, and Prostatitis Flashcards
UTI can be __ or __
uncomplicated (cystitis, pyelonephritis in non pregnant)
complicated - all the other cases
What are the risk factors for acute cystitis? 7
diaphragm high frequency intercourse previous UTI diabetes incontinence new sexual partner maternal history
In diabetic patients long term use of __ and __ increase the risk for UTI
insulin
SGLT2
UTI in men is more common when >_, due to __ hypertrophy. __ reduce the risk as well
45
prostate
circumcision
The main pathogens causing uncomplicated UTI and pyelonephritis are: 6
E.coli staph saprophyticus enterococcus proteus Klebsiella Citrobacter
The main pathogens causing complicated UTI and pyelonephritis are: 6
E.coli proteus Klebsiella pseudomonas aeruginosa actinobacteria Citrobacter
What are the classic symptoms of cystitis?
dysuria
urgency and frequency
nocturia
What are the classic symptoms of pyelonephritis?
low fever
lower back/rib pain
Severe pyelonephritis will present with: 5
high fever nausea vomiting flank pain papillary necrosis
Xanthogranulomatous pyelonephritis=__
combination of chronic infection + urinary obstruction - resulting in pus destroying the kidney parenchyma
only certain strains of __ will transform __ into nitrite
Enterobacteriaceae
nitrate
Uncomplicated cystitis with unspecific symptoms requires __. If __ or __ are + -> __treatment. If it is negative: __ or__
urine stick nitrite leukocytes empiric culture follow up
Men with cystitis should be tested with __. If there is fever as well- __/__
culture
US/CT
Treating uncomplicated cystitis in women can be done with __/__/__ - they will have a minimal influence in the flora, while __/__/__ will have a more significant effect.
nitrofurantoin pivmecillinam fosfomycin quinolones TMP-SMX ampicillin
Fosfomycin can be given in a __ dose
single
What will you use to treat pseudomonas UTI?
fluoroquinolones (ciprofloxacin/levofloxacin)
What are the downsides of using fluoroquinolones to treat UTI?
increasing resistance
Achilles tendon rapture
irreversible neuropathy
What is the first line of treatment for pyelonephritis? mention 4 other recommended treatments
fluoroquinolones
TMX-SMX (if the pathogen is sensitive) + ceftriaxone (if the sensitiveness is unknown)
carbapenem
cephalosporine
If the patient has recqurent pyelonephritis or resistant strain/previous procedure in urinary system treat with-__
carbapenem
What is the drugs of choice for pyelonephritis during pregnancy? 3
cephalosporines
ampicillin
nitrofurantoin
Women with ASB should be treated for - days, pregnant + pyelonephritis should receive IV __ +/- __
beta lactam
aminoglycoside
When treating pyelonephritis, which drug should be avoided during the 1st trimester and near the time of birth? why?
sulfonamides
cause cartilage damage to the embryo
What is the drug of choice for pyelonephritis in men?
fluoroquinolones or TMX-SMX
What is the recommended treatment for xanthogranulomatous complicated UTI?
nephrectomy
What is the recommended treatment for emphysematous complicated UTI?
percutaneous drainage followed by nephrectomy if needed
What is the recommended treatment for papillary necrosis complicated UTI?
open the obstruction
Which patients must be treated for ASB? 4
pregnant
prior to UG surgery
neutropenic
post kidney transplantation
CAUTI=__
catheter associated UTI
What is one of the most important steps in treating CAUTI?
replace the catheter + Abx
What is the first line of treatment for candiduria?
in asymptomatic- remove catheter
if symptomatic/high risk/prior to UG surgery-fluconazole for 7-14 days.
if the strain is resistant- amphotericin B/flucytosine
