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PDAT6 ID > 26 - UTI & Prostatis > Flashcards

26 - UTI & Prostatis Flashcards

1
Q

Clinical Presentation

ATYPICAL SYMPTOMS - ELDERLY
UTI

A

MENTAL STATUS CHANGES

Changes in Eating / GI issues

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2
Q

TREATMENT + DURATION

  • *UTIs in MALES**
  • *Complicated UTI** since MALE
A

Initial Infection:
10-14 DAYS

Nitrofurantoin 100mg q12 or Bactrim DS q12
Recurrent Infection: 6+ weeks

Generally caused by:
Catheterization / Instrumentation / Stones
Older Men:
Prostatic Hypertrophy or Prostatitis​

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3
Q

TREATMENT + DURATION

UTI in PREGNANCY
(Includes Asymptomatic Bacteremia)

A

Pregnant
significant bacteriuria –> treat to prevent complications

CEPHALEXIN 500mg q6h for 7 DAYS
or
AMOXICILLIN 250 q8h for 7 DAYS

avoid tetracyclines / sulfonamides / FQs in pregnant

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4
Q

Diagnosis of UTIs

  • *URINALYSIS**
  • must distinguish contamination from infection*
A

Dipstick
pH / glucose / protein / ketones / blood / bilirubin
Nitrate Reduction Test
LE = Leukocyte esterease Test

Microscopic Exam:
WBC - pyruria is nonspecific –> just inflammation

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5
Q

Etiology

COMPLICATED/Nosocomial UTI
(All others, not women 15-45y/o)

A

E.COLI
50%

Enterococci
2nd

Proteus / Kleb / Enterobacter / Pseudomonas

Staphylococci

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6
Q

TREATMENT + DURATION

Recurrent Infection

RELAPSE (20%) = SAME Bug

A

Relapse = Same Bug
Indicates:
renal involvement / structural abnormality / chronic prostatitis

Treat with:
FULL 2 WEEK COURSE
if RELAPSE after 2 weeks:
Treat for ANOTHER 2-4 weeks
if relapse after 6 weeks…. –> treat for 6 months or longer

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7
Q

Diagnosis of UTIs

  • *URINE CULTURE**
  • must distinguish contamination from infection*
A

Calibrated loop technique
for quantification

Id done by
kits / rapid tests / biochem tubes

  • *Susceptibility Tests**
  • *disk diffusion**: kirby-bauer, e-test
  • *broth dilution**: MICs
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8
Q

Pathogenesis / Etiology

PROSTATIS

A

exact mechanism UNKNOWN
STILL E.COLI (>75%)

Reflux of infected urine –> prostatic ducts

Factors contributing:
↓PAF = Prostatic Antibacterial Factor
in prostatitis & elderly

Altered pH of prostatic secretions
normal = 6.6-7.6
prostatis + elderly = pH 7-9

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9
Q

TREATMENT

Symptomatic Abacteriuria

A
  • *Systemic Abacteriuria = Acute Urethral Syndrome**
  • *(Dysuria + Pyuria but…. little to no organisms found)​**

Same as Uncomplicated Cystitis Treatment
Nitrofurantoin or Trimethoprim
BID 3/5 days

  • *if CHLAMYDIA suspected:**
  • *DOXYCYCLINE** or AZITHROMYCIN
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10
Q

Clinical Presentation

LOWER TRACT INFECTIONS
Cystitis (Bladder) / Urethritis / Prostatitis

A

Lower Tract Infections

  • *Dysuria**
  • *urgency + Frequency**

Nocturia

Suprapubic Heaviness or PAIN

Gross Hematuria

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11
Q

Diagnosis / Clinical Presentation

Acute Bacterial Prostatitis

A

Clinical Presentation
Systemic - Fever / Chills / Malaise / Pain
Same Urinary Sxs

Diagnosis

  • *Digital palpatation of Prostate**: swollen / tender / warm
  • *Presence of SIGNIFICANT BACTERIURIA**
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12
Q

Predisposing Factors of UTI

A
  • *Structural Abnormalities**
  • *OBSTRUCTION:** prostatic hypertrophy / calculi
  • *Neurologic Malfunctions**
  • *Stroke / Diabetes / Spinal Cord Injuries**
  • lose ability to VOID the bacteria*
  • *Vesicoureteral Reflux**
  • *urine is forced UP the ureter –> kidney**

Catherers** + **Pregnancy

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13
Q

TREATMENT

Acute Uncomplicated Cystitis
(Bladder Infection in Females 15-45y/o)

A
  • *NITROFURANTOIN 100mg q12hrs**
  • *5 DAYS**

or

BACTRIM DS q12hrs
can be 3 DAYS
2nd line due to HIGHER resistance

quinolones no longer preferred due to resistance

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14
Q

Pathogenesis of UTIs

Host Defense Mechanisms

A

Host Defense Mechanisms

  • *URINE’s:**
  • *pH / osmolality / urea concentration**

Bacteria in bladder –> STIMULATES URINATION

  • *ANTI-ADHERENCE MECHANISMS**
  • prevents bacterial attachment to bladder*

Bacterial Virulence Factors = FIMBRIAE for adhesion

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15
Q

TREATMENT + DURATION

CHRONIC PROSTATITIS
characterized by RECURRENT UTIs w/ same pathogen

Clinical Presentation Varies:

  • *Light/Vague urinary symptoms**
  • *Many asymptomatic**
  • prostate gland OFTEN NORMAL*
A

> 6 WEEKS OF THERAPY

treat with:
Fluoroquinolone –> good concentration @ prostate
CIPROFLOXACIN 500mg q12h
or
LEVOFLOXACIN 500mg QD

second line:
Bactrim DS q12 –> 4-6 weeks

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16
Q

TREATMENT + DURATION

Mild-Moderate Acute Pyelonephritis
Complicated UTI

A

do NOT use MACROBID –> does NOT reach above the bladder

Mild-Moderate Acute Pyelonephritis
oral therapy for:
2 WEEKS

E. Coli + other Enterobacteriaceae
BACTRIM DS q12h or Fluoroquinolone - DOC

for enterococci:
AMPICILLIN** or **AMOXICILLIN

17
Q

Etiology

  • *Uncomplicated UTI**
  • *(Females 15-45y/o**)
A

E. COLI
85%>

Staphylococcus Saprophyticus
5-15%

Enterococcus Faecalis

Others:
Kleb / Proteus / Pseudomonas

18
Q

TREATMENT + DURATION

SERIOUSLY ILL PATIENT
Acute Pyelonephritis
Complicated UTI

A

SEVERE Acute Pyelonephritis

  • *2 WEEKS**
  • can transition to ORAL after febrile for 1-2days*

Requires:
HOSPITILIZATION + INTRAVENOUS (IV) ABx

AMINOGLYCOSIDE** + **BETA LACTAM

Renal Insufficiency:
Quinolone +/- B-Lactam

19
Q

TREATMENT + DURATION

ACUTE PROSTATITIS
Severe Illness w/ fever + urinary&constitutional symptoms

A
  • *4-6 WEEKS TOTAL**
  • *IV –> PO** if respond to 5-7 days of IV Abx
  • until afebrile + less symptomatic*

AG + B-lactam

AminoGlycosides = GAT
Gentamicin** / **Amikacin** / **Tobramycin
+
B-Lactam
Pip-Tazo** / **Aztrenam** / **3rd gen Ceph

20
Q

Clinical Presentation

UPPER TRACT INFECTIONS
Pyelonephritis (kidney)

A

UPPER TRACT INFECTIONS

  • *SYSTEMIC SYMPTOMS**
  • *Fever / Rigors / HA / NV** / Malaise

Flank Pain

Costovertebral Tenderness

ABdominal Pain

21
Q

TREATMENT

Asymptomatic Bacteriuria

A
  • *Asymptomatic Bacteriuria**
  • no symptoms* –> large # of bacteria in urine

Conventional Therapy only for:
CHILDREN**+**PREGNANT**+**PRIOR to INSTRUMENTATION
(Stent / Surgical Procedure)

elderly generally not treated

NITROFURANTOIN 100mg q12hrs
5 DAYS

BACTRIM DS q12hrs
can be 3 DAYS

22
Q

TREATMENT + DURATION

Recurrent Infection

RE-INFECTION (80%) = Different Bug

A

<3 / year = Infrequent –> normal short-course therapy

LONG-TERM PROPHYLACTIC THERAPY
>3 /year
generally do not recommend
esp the low dose for long times –> resistance risk

23
Q

Duration + De-escalation Therapy

ACUTE PYELONEPHRITIS

A

AMINOGLYCOSIDE + BETA LACTAM
for
2 WEEKS TOTAL

Effective = Stabilize patient in 12-24 hours
VVV
IV Therapy until Afebrile for >24-48 Hours
VVVV
Transition to ORAL THERAPY

24
Q

TREATMENT + DURATION

CATHERIZED PATIENTS

A

Very common to find bacteriuria in catherized patients
<30 days –> remove catheter

only treat if SYMPTOMATIC
treat like a complicated UTI (2 weeks)

do NOT treat if ASYMPTOMATIC

PDAT6 ID (31 decks)

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