9. UTI & Prostatitis MT2 Flashcards
does this describe a bladder infection or kidney infection?
cystitis, or lower UTI
bladder infection
does this describe a bladder infection or kidney infection?
pylonephritis, or upper UTI
kidney infection
this is the presence of significant amounts of bacteria in the urine without accompanying signs/symptoms of infection
asymptomatic bacteriuria
this is a lower tract disease (cystitis) that presents with dysuria, frequency, urgency and suprapubic tenderness
uncomplicated UTI
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
complicated UTI
this is a UTI occurring in patients who are currently catheterized or have been catheterized within the previous 48 hours
CAUTI
this is inflammation of the renal parenchyma, calcies, and pelvis particularly due to local bacterial infection
pyelonephritis
this is sepsis resulting from the infection of extravasated urine or obstruction of infected urine
urosepsis
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
urinalysis
what is a urinalysis ‘technique’ to get a sample that is not contaminated
midstream catch - let some urine go and then get sample as the initial urine can contaminate the sample
what is seen in urinalysis for a UTI
- 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)
what do gram stains tell us regarding UTIs
- 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
what does culture & susceptibility test tell use regarding UTIs
- what bacteria are on the growth media
- biochemical tests are used for indentification
- what antibiotics bugs are susceptible to
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
Coliforms
this is a larger group of gram-negative bacilli; includes: coliforms, proteus, salmonella, Morganella, etc.
enterobacteriaceae
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
coagulase negative staphylococcus
true or false: fever, tachycardia and hypotension are seen in cystitis
false
true of false: increased peripheral blood WBCs in cystitis
false
true or false: WBC casts are present in cystitis
false
when are the only times asymptomatic bacteriuria should be treated
- pregnancy
- before transurethral resection of the prostate (TURP procedure) and urological procedures where mucosal bleeding is anticipated
- bacteriuria persisting > 48 hours after catheter removal
what bacteria causes asymptotic bacteriuria
aerobic gram negative bacilli
what is used for treatment of asymptomatic bacteriuria
TMP/SMX DS P.O x 3 days
what bacteria causes asymptomatic bacteriuria in pregnancy
aerobic gram negative bacilli & coagulase-negative staph
what is used for treatment of asymptomatic bacteriuria in pregnancy
amoxicillin, clay, cephalexin, fosfomycin (depending on trimester nitrofurantoin or TMP/SMX) x 3-7 days
what are the common pathogens of uncomplicated cystitis
- e.coli (and other enterobacteriae)
- coagulate neg staph (saprophyticus)
- enterococcus
what is the first line treatment for uncomplicated cystitis
nitrofurantoin PO x 5 days
fosfomycin PO x 1 dose
second line: TMP/SMX DS or ciprofloxacin PO x 3 days
what is the treatment for uncomplicated cystitis in pregnancy
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
what defines the need for prophylaxis treatment on recurrent uncomplicated cystitis
3 or more episodes per year
what is the treatment for prophylaxis of recurrent UTIs related to coitus
TMP/SMX or Nitrofurantoin PO pericoitus
what is the treatment for prophylaxis of recurrent UTIs not related to coitus
TMP/SMX PO hs or 3x/week or Trimethoprim PO hs x 6 weeks
what are the common pathogens of complicated UTI
- e.coli and other enterbacteriae
- enterococcus spp
- s. agalactiae
- pseudomonas
- corynebacterium urealyticum
- aerococcus urinae
what is used for the treatment of a complicated UTI in a patient who is afebrile/systemically well
- amoxicillin/clav PO
- cefixime PO
- cipro PO
- TMP/SMX PO
what is used for treatment of a complicated UTI in a patient who is febrile/systemically unwell
- Ampicillin + Gentamicin IV
- ceftriaxone IV
what is used for treatment for a complicated UTI in a patient who is septic or hemodynamically stable
- pip/tazo IV +/- gentamicin IV (consider adding gentamicin if septic, recent abx use or history of MDR organisms)
is there a culture in urine, blood or both in pyelonephritis
both!
what are the usual pathogens in pyelonephritis
- E. coli and other enterobacter spp
- enterococcus spp
what is the treatment for uncomplicated/moderately ill pyelonephritis
- amoxicillin/clav PO x 14 days
- cipro PO x 7 days
- TMP/SMX PO x 14 days
what is the treatment for hospitalized pyelonephritis
- Ampicillin + Gentamicin IV x 14 days
- Ceftriaxone IV x 14 days
- Cipro IV x 14 days
- Tazocin IV x 14 days
what is the treatment for pyelonephritis in pregnancy
- Ampicillin + Gentamicin IV x 14 days
- Ceftriaxone IV x 14 days
true or false: step-down from IV to PO can occur for treatment of pyelonephritis
true: based on culture & susceptibility test and whether pt can tolerate oral med
what is an important pharmacokinetic consideration (think ADME) for drugs used to treat both lower and upper urinary tract infections
Use renally cleared drugs - need to reach the site of infection!!!
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
prostatits
this is a prostatitis syndrome; severe symptoms, systemic infection, acute bacterial UTI
acute bacterial prostatitis
this is a prostatitis syndrome; chronic bacterial infection of the prostate +/- signs/symptoms of prostatitis. usually in setting of recurrent UTI (same strain)
chronic bacterial prostatits
this is a prostatitis syndrome; chronic pelvic pain +/- dysuria in absence of UTI. may be categorized as inflammatory or noninflammatory
chronic pelvic pain syndrome
this is a prostatitis syndrome; incidental finding of inflammation in absence of genitourinary tract symptoms
asymptomatic inflammatory
what are the common pathogens of prostatitis
most common is e. coli
- klebsiella
- proteus
less common: pseudomonas, enterobacter, serratis, gram +ve organisms
how is prostatitis diagnosed
- prostate is tender and enlarged upon examination
- STI ruled out
- urine culture
- blood culture
what is used for treatment of acute, mild/moderate prostatitis
- cipro PO
- TMP/SMX
for 2-4 weeks
what is used for treatment of acute severe prostatitis
pip/tazo IV for 2-4 weeks
what is used for treatment of chronic prostatitis
- cipro PO
- TMP/SMX PO
- Doxy PO
for 4-6 weeks (may require up to 12 weeks)
