240 UTI Flashcards
What factors suggest a complicated UTI?
functional/anatomic abnormality of tract male sex pregnancy elderly patients diabetic or immunosuppressed patients and more
What bacterial virulence factors aid in urinary tract colonization?
adhesins (ex. pili)
determine the extent of infection
What are the clinical features of cystitis?
frequency, urgency, dysuria
What are the clinical features of pyelonephritis?
chills, fever, flank pain + frequency/urgency/dysuria
What are the clinical features of prostatitis?
chills, fever, prostate pain + frequency/urgency/dysuria
When are imaging studies used for UTIs?
in men and compromised patients
also in patients who do not respond to therapy
What are indications for radiologic investigation in acute clinical pyelonephritis?
concern for obstruction or history of calculi
potential papillary necrosis
history of genitourinary surgery
poor response to treatment
underlying conditions (diabetes mellitus, polycystic kidney disease, neuropathic bladder)
infection with unusual organisms
What is the mechanism of beta-lactam drugs?
inhibition of cell wall synthesis
examples: penicillins, cephalosporins, aztreonam
What is the mechanism of aminoglycosides?
inhibition of ribosomal protein synthesis
examples: gentamicin, streptomycin
What is the mechanism of quinolone antibiotics?
inhibition of bacterial DNA gyrase
examples: ciprofloxacin, levofloxacin
What is the mechanism of fosfomycin antibiotics?
inhibition of bacterial cell wall synthesis
What is the mechanism of nitrofurantoin?
inhibition of several bacterial enzyme systems
What is the mechanism of trimethoprim-sulfamethoxazole?
antagonism of bacterial folate metabolism
What is the mechanism of vancomycin?
inhibition of bacterial cell wall synthesis (at beta-lactams)
What class of antibiotics is associated with acute interstitial nephritis?
methicillin (and other antistaphylococcal penicillins)
What is the major side effect associated with antipseudomonal penicillins?
hypernatremia
Which class of antibiotics is associated with ototoxicity and nephrotoxicity?
aminoglycosides
What class of antibiotics is associated with photosensitivity and CNS effects?
fluoroquinolones
Which patients have contraindications to fluoroquinolones?
children and pregnant patients
Which antibiotic is associated with red man syndrome?
vancomycin
also associated with nephrotoxicity and ototoxicity when combined with other drugs
How long should uncomplicated bladder infections be treated?
treated for 3 days with most drugs
treat for 5 days with nitrofurantoin
When should asymptomatic bacteriuria be treated?
pregnant woman
prior to urologic intervention
What is the treatment for acute prostatitis?
fluoroquinolone therapy for 7-10 days initiated immediately
modify drug after urine culture
What is the treatment for chronic prostatitis?
TMP-SMX or FQ (depending on culture) for 3 months
What radiologic findings are associated with emphysematous pyelonephritis?
gas in parenchyma or collecting system
managed surgically, life threatening
How are renal abscesses managed?
IV antimicrobials and abscess drainage for large abscesses
What is the microscopic hallmark of malacoplakia?
michaelis-gutman bodies
When should pregnant women be screened for bacteruria?
first trimester
When should bacteriuria be treated in the elderly?
never if asymptomatic
very common and not related to UTI or renal function
When should catheter-associated UTIs be treated?
only if symptomatic
What is the most common cause of acute pyelonephritis in young women?
p-pillated e coli
Excluding history of previous allergy, what drug is safe during any phase of pregnancy?
penicillin
What is the optimal antimicrobial agent for treatment of acute pyelonephritis in young women?
fluoroquinolone
What are the drugs of choice for the treatment of uncomplicated cystitis in most young women?
TMP-SMX; nitrofurantoin
