4 - UTI Flashcards
What pathogen is the most frequent cause of UTIs?
E. Coli
A colony count of greater than _______ CFU/ml is consistent with an UTI.
10,000
What 4 features make up the classic presentation of an UTI?
- dysuria
- urinary frequency
- urinary urgency
- subprapubic pain
What 3 conditions are on the differential diagnosis for an UTI in men?
- acute bacterial prostatitis
- chronic prostatitis
- urethritis
What 3 conditions are on the differential diagnosis for an UTI in women?
- vaginitis
- urethritis
- PID
What 2 findings on urine dipstick is consistent with UTIs?
- leukocyte esterase
- nitritis
What 2 bacterias do not have the enzyme that produces nitrites?
- S. saprophyticus
- Enterococcus
What are the 3 first line agents available for treating UTIs?
- Nitrofurantoin (Macrobid)
- Bactrim
- Fosfomycin
For patients with high risk for MDR what 3 treatment options are available for UTIs?
- Nitrofurantoin
- Fosfomycin
- Pivmecillinam
What urinary tract topical analgesic is used to relieve dysuria in patients with UTIs?
Phenazopyridine (Pyridium)
What is the main adverse effect of Pyridium?
- will turn body secretions/excretions orange
Persistent symptoms for _____ hours warrants a repeat urine culture.
- 48-72 hours
* or recurrent symptoms within a few weeks
A patient presents with nausea, vomiting, fever, and CVA tenderness on the affected side. What complicated UTI is this presentation consistent with?
Pyelonephritis
This is defined as inflammation of the kidney and renal pelvis.
Pyelonephritis
WBC casts on UA is consistent with what UTI?
Pyelonephritis
If a patient with pyelonephritis is not getting better and imaging is warranted, what is the study of choice?
CT of the abdomen and pelvis
Mild to moderate pyelonephritis can be treated with any of these 3 drug choices.
- Ciprofloxacin
- Levofloxacin
- Bactrim
Patients with complicated UTI that are critically ill or patients with urinary tract obstructions can be treated with a combination of these 2 drugs.
- Carbapenem + Vancomycin
By what % does the risk of bacteruria rise per day with indwelling catether insertion?
5%
T/F: bacteriuria in pregnant women should be treated.
True
What antibiotic class is contraindicated in pregnancy as it is toxic to developing cartilage in fetus?
FQs
This is defined as an inflammation of the urethra secondary to an infection or trauma.
Urethritis
Dysuria, burning and a mucoid watery discharge from the urethral meatus is consistent with what UTI?
Urethritis (Gonorrhea)
A patient with urethritis has frank pus. What pathogen do you think is the cause?
- Gonorrhea
A patient with urethritis only complains of dysuria, there is no pus. What pathogen do you think is the cause?
- Chlamydia
A patient with urethritis only complains of dysuria and genital ulcers. What pathogen do you think is the cause?
- Genital HSV
Presence of 1 out of 3 of the following is required to diagnose urethritis in real time.
- Mucopurulent discharge
- Leukocyte esterase or > 10 WBCs/hpf on first catch urine
- > 2 WBCs/hpf oil immersion field from the gram stain of a urethral swab
This test is used to definitively diagnose urethritis but the results are often delayed.
NAAT
What is the empiric treatment at the point-of-care for urethritis?
- Ceftriaxone 500 mg IM x 1
- Azithromycin 1g PO x 1
What is the nongonoccocal treatment protocol that only targets Chlamydia?
- Azithromycin 1g PO x 1
- Doxycycline 100 mg bid x 7 days
Patients with urethritis are instructed to refrain from sexual activity for how long?
7 days
