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pharmacotherapy 4270 > 9. UTI & Prostatitis MT2 > Flashcards

9. UTI & Prostatitis MT2 Flashcards

1
Q

does this describe a bladder infection or kidney infection?
cystitis, or lower UTI

A

bladder infection

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2
Q

does this describe a bladder infection or kidney infection?
pylonephritis, or upper UTI

A

kidney infection

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3
Q

this is the presence of significant amounts of bacteria in the urine without accompanying signs/symptoms of infection

A

asymptomatic bacteriuria

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4
Q

this is a lower tract disease (cystitis) that presents with dysuria, frequency, urgency and suprapubic tenderness

A

uncomplicated UTI

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5
Q

this is a metabolic, functional or structural abnormality and may involve both lower and upper tracts. has increased rate of treatment failure. males. systemic symptoms may include fever, increased leukocytes and decreased BP

A

complicated UTI

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6
Q

this is a UTI occurring in patients who are currently catheterized or have been catheterized within the previous 48 hours

A

CAUTI

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7
Q

this is inflammation of the renal parenchyma, calcies, and pelvis particularly due to local bacterial infection

A

pyelonephritis

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8
Q

this is sepsis resulting from the infection of extravasated urine or obstruction of infected urine

A

urosepsis

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9
Q

this is one of the oldest practices in medicine; it detects abnormalities of multiple diseases. includes multiple tests such as specific gravity, pH, protein, glucose, ketones, bilirubin, occult blood, leukocytes esterase, nitrate, urobilinogen, WBCs, RBCs, casts and bacteria

A

urinalysis

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10
Q

what is a urinalysis ‘technique’ to get a sample that is not contaminated

A

midstream catch - let some urine go and then get sample as the initial urine can contaminate the sample

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11
Q

what is seen in urinalysis for a UTI

A
  • bacteriuria (bacteria in urine)
  • hematuria (blood in urine)
  • nitrites (presence of bacteria that convert nitrate to nitrite e.g. E.coli)
  • pyuria (WBC’s in urine - may indicate inflammation including infection)
  • WBC casts (indicate renal origin of leukocytes)
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12
Q

what do gram stains tell us regarding UTIs

A
  • WBCs indicate whether or not there is an infection
  • epithelial cells indicate whether or not the sample is contaminated
  • tell us if for e.g. gram positive cocci, gram negative bacilli
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13
Q

what does culture & susceptibility test tell use regarding UTIs

A
  • what bacteria are on the growth media
  • biochemical tests are used for indentification
  • what antibiotics bugs are susceptible to
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14
Q

these are members of the normal intestinal flora of humans and animals and may be isolated from a variety of environmental sources (e.g. E.coli, Klebsiella, Enterobacter, Serratia, Citrobacter); all are gram-negative bacilli

A

Coliforms

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15
Q

this is a larger group of gram-negative bacilli; includes: coliforms, proteus, salmonella, Morganella, etc.

A

enterobacteriaceae

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16
Q

a positive coagulase test differents S. aureus from this group. they are part of the normal flora of the skin. have a relatively low virulence but are often resistant to common antibiotics. includes S. epidermidis, S. saprophyticus and S. hemolyticus

A

coagulase negative staphylococcus

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17
Q

true or false: fever, tachycardia and hypotension are seen in cystitis

A

false

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18
Q

true of false: increased peripheral blood WBCs in cystitis

A

false

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19
Q

true or false: WBC casts are present in cystitis

A

false

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20
Q

when are the only times asymptomatic bacteriuria should be treated

A
  • pregnancy
  • before transurethral resection of the prostate (TURP procedure) and urological procedures where mucosal bleeding is anticipated
  • bacteriuria persisting > 48 hours after catheter removal
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21
Q

what bacteria causes asymptotic bacteriuria

A

aerobic gram negative bacilli

22
Q

what is used for treatment of asymptomatic bacteriuria

A

TMP/SMX DS P.O x 3 days

23
Q

what bacteria causes asymptomatic bacteriuria in pregnancy

A

aerobic gram negative bacilli & coagulase-negative staph

24
Q

what is used for treatment of asymptomatic bacteriuria in pregnancy

A

amoxicillin, clay, cephalexin, fosfomycin (depending on trimester nitrofurantoin or TMP/SMX) x 3-7 days

25
Q

what are the common pathogens of uncomplicated cystitis

A
  • e.coli (and other enterobacteriae)
  • coagulate neg staph (saprophyticus)
  • enterococcus
26
Q

what is the first line treatment for uncomplicated cystitis

A

nitrofurantoin PO x 5 days
fosfomycin PO x 1 dose

second line: TMP/SMX DS or ciprofloxacin PO x 3 days

27
Q

what is the treatment for uncomplicated cystitis in pregnancy

A

fosfomycin PO x 1 dose
cefixime PO x 7 days

*avoid TMP/SMX in 1st and 3rd trimester
*avoid Nitrofurantoin in 3rd semester
*DO NOT use ciprofloxacin

28
Q

what defines the need for prophylaxis treatment on recurrent uncomplicated cystitis

A

3 or more episodes per year

29
Q

what is the treatment for prophylaxis of recurrent UTIs related to coitus

A

TMP/SMX or Nitrofurantoin PO pericoitus

30
Q

what is the treatment for prophylaxis of recurrent UTIs not related to coitus

A

TMP/SMX PO hs or 3x/week or Trimethoprim PO hs x 6 weeks

31
Q

what are the common pathogens of complicated UTI

A
  • e.coli and other enterbacteriae
  • enterococcus spp
  • s. agalactiae
  • pseudomonas
  • corynebacterium urealyticum
  • aerococcus urinae
32
Q

what is used for the treatment of a complicated UTI in a patient who is afebrile/systemically well

A
  • amoxicillin/clav PO
  • cefixime PO
  • cipro PO
  • TMP/SMX PO
33
Q

what is used for treatment of a complicated UTI in a patient who is febrile/systemically unwell

A
  • Ampicillin + Gentamicin IV
  • ceftriaxone IV
34
Q

what is used for treatment for a complicated UTI in a patient who is septic or hemodynamically stable

A
  • pip/tazo IV +/- gentamicin IV (consider adding gentamicin if septic, recent abx use or history of MDR organisms)
35
Q

is there a culture in urine, blood or both in pyelonephritis

A

both!

36
Q

what are the usual pathogens in pyelonephritis

A
  • E. coli and other enterobacter spp
  • enterococcus spp
37
Q

what is the treatment for uncomplicated/moderately ill pyelonephritis

A
  • amoxicillin/clav PO x 14 days
  • cipro PO x 7 days
  • TMP/SMX PO x 14 days
38
Q

what is the treatment for hospitalized pyelonephritis

A
  • Ampicillin + Gentamicin IV x 14 days
  • Ceftriaxone IV x 14 days
  • Cipro IV x 14 days
  • Tazocin IV x 14 days
39
Q

what is the treatment for pyelonephritis in pregnancy

A
  • Ampicillin + Gentamicin IV x 14 days
  • Ceftriaxone IV x 14 days
40
Q

true or false: step-down from IV to PO can occur for treatment of pyelonephritis

A

true: based on culture & susceptibility test and whether pt can tolerate oral med

41
Q

what is an important pharmacokinetic consideration (think ADME) for drugs used to treat both lower and upper urinary tract infections

A

Use renally cleared drugs - need to reach the site of infection!!!

42
Q

this is known as inflammation of the prostate. most men present with discomfort or pain in the pelvic region for at least 3 months
may be caused by reflux from the urethra or depletion of prostatic antibacterial factor
symptoms: fever, chills, dysuria, frequency, bladder outlet obstruction, prostate tenderness, myalgia, recurrent UTI

A

prostatits

43
Q

this is a prostatitis syndrome; severe symptoms, systemic infection, acute bacterial UTI

A

acute bacterial prostatitis

44
Q

this is a prostatitis syndrome; chronic bacterial infection of the prostate +/- signs/symptoms of prostatitis. usually in setting of recurrent UTI (same strain)

A

chronic bacterial prostatits

45
Q

this is a prostatitis syndrome; chronic pelvic pain +/- dysuria in absence of UTI. may be categorized as inflammatory or noninflammatory

A

chronic pelvic pain syndrome

46
Q

this is a prostatitis syndrome; incidental finding of inflammation in absence of genitourinary tract symptoms

A

asymptomatic inflammatory

47
Q

what are the common pathogens of prostatitis

A

most common is e. coli
- klebsiella
- proteus

less common: pseudomonas, enterobacter, serratis, gram +ve organisms

48
Q

how is prostatitis diagnosed

A
  • prostate is tender and enlarged upon examination
  • STI ruled out
  • urine culture
  • blood culture
49
Q

what is used for treatment of acute, mild/moderate prostatitis

A
  • cipro PO
  • TMP/SMX
    for 2-4 weeks
50
Q

what is used for treatment of acute severe prostatitis

A

pip/tazo IV for 2-4 weeks

51
Q

what is used for treatment of chronic prostatitis

A
  • cipro PO
  • TMP/SMX PO
  • Doxy PO
    for 4-6 weeks (may require up to 12 weeks)

pharmacotherapy 4270 (19 decks)

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