238: UTI Flashcards
What is the serious adverse effect associated with beta-lactams?
Allergy
Collateral damage to natural flora
What are the drug of choice for uncomplicated cystitis? (2)
TMP-SMX (3 days) or Nitrofurantoin (5 days)
Why might a patient have UTI symptoms but no bacteria on urinalysis or culture?
Because the urinary tract is infected, not the urine itself
Pts are considered infected with a UTI if they have consistent symptoms
List the indications for imaging in patients with UTI
- Complicated UTI
- Failure to respond after 3 days of therapy
NOTE: image after no response to therapy after 72h of therapy in UTI, or 5-6 days in pyelonephritis
List 3 symptoms commonly associated with acute pyelonephritis
Chills
Fever
Flank pain
What virulence factor is most important for bacterial adherence?
Pili
List 4 host factors that promote colonization of bacteria in the urinary tract
- Sexual activity
- Increases inoculation
- Spermicide
- Allows bacteria to bind
- Estrogen binding
- Allows bacteria to bind
- Antimicrobials
- Decrease indiginous flora, which exposes more receptors
What is the next step in management when a patient presents with symptoms of a UTI?
Urinalysis
(Can treat emperically before results come back, do not need to culture)
List 3 symptoms of cystitis
Dysuria (painful urination)
Urgency
Frequency
Cystitis = bladder infection; common type of UTI
Which bacteria is the most common cause of UTI?
E. coli
What is the difference between complicated and uncomplicated UTI?
- Uncomplicated
- Normal urinary tract
- Usually people with female genitalia
- People with normal male genitalia usually do not get UTIs
- Complicated
- Abnormal urinary tract (in structure or function)
- Any child and anybody with male genitalia who gets a UTI probably has a complicated UTI
- Pregnant people
How does the treatment of uncomplicated cystitis differ in reinfection vs. persistent infection?
- Re-infection
- Usually a longer interval, different bacteria
- Manage medically with antibiotics
- Persistent infection (much less common)
- Short interval, same bacteria
- Image and treat surgically (remove potential stone that is seeding infection)
- If no imaging fingings, try low-dose prophylaxis for a long tiem
Which class of antibiotics is best for treating acute pyelonephritis in young women?
Fluroquinolone for 7-14 days
Which patient group requires treatment for asymptomatic bacteruria?
Pregnant women
Do not treat asymptomatic bacteruria in anyone else!
Which of these drugs would you select for treatment in this situation?
Drug A - has the highest margin of error
(Want a drug that has urinary levels way above required MIC to kill the bug)
Describe the pathogenesis (Key early events) in UTI pathogenesis
- Pathogenic bacteria stick to epithelial cells
- Cells phagocytosed, immune system activated (cytokines), WBCs recruited
- Bacteria work to try to block the cytokines so they can get some traction
What is the difference between complicated and uncomplicated pyelonephritis?
Obstruction = complicated (need to relieve)
No obstruction = uncomplicated
What is the serious adverse effect associated with fluoroquinolones?
Tendonitis, allergy
Collateral damage to natural flora
What is the serious adverse effect associated with nitrofurantoin?
Pulmonary fibrosis
Which drug used to treat UTI is safest during any phase of pregnancy?
Beta lactams
(Penicillins and cephalosporins)
Which antibiotic agents used to treat UTI are most likely to cause “collateral damage” by disrupting the normal urinary flora? (2)
Fluoroquinolones
Beta-lactams
What is the serious adverse effect associated with TMP-SMX?
Rash
(And Stevens-Johnson syndrome)
What is the most common cause of acute pyelonephritis in young women?
(Which pathogen)
P-piliated E. coli
In addition to antibiotics, what treatment should be considered for the management of a small perirenal abscess in a functioning kidney?
Percutaneous drainage
What is the appropriate managment of a complicated UTI?
Do imaging
Manage medically and/or surgically depending on findings
