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Urology > A/15. Cystitis and urethritis > Flashcards

A/15. Cystitis and urethritis Flashcards

1
Q

classification of cystitis and urethritis

A
  • Anatomic
    *lower: urethritis, cystitis (superficial infection of bladder)
    *Upper: pyelonephritis, renal or perinephric abscess, prostitis
  • clinical:
    *Non-complicated: non-preg, immunocompetent.. etc
    *complicated: Upper tract infection in women, any UTI in men or pregnant women
    or UTI with underlying structural disease, immunosup
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2
Q

Non complicated UTI examples

A
  • Cystitis in immunocompetent,
  • non-pregnant women,
  • without underlying
    structural or neurologic disease
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3
Q

complicated UTI examples

A
  • Upper tract infection in women
  • any UTI in men
  • UTI in pregnant women,
  • UTI with underlying structural disease,
  • or immunosuppression
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4
Q

Upper UTI

A
  • Pyelonephritis (inflammatory process of renal parenchyma)
  • Renal or perinephric abscess
  • Prostatitis
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5
Q

lower UTI

A
  • Urethritis
  • Cystitis (superficial infection of bladder)
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6
Q

Who to screen for Asymptomatic bacteriuria

A

screen and treat it positive in
* pregnant women
* any patient prior to urologic surgery

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7
Q

causes of increased urinary WBC (pyuria):

A
  • Vaginal discharge
  • Urinary stone
  • Urinary tract tumor
  • Urethritis
  • Interstitial nephritis
  • Renal TB
  • Foreign body
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8
Q

Risk factors for complicated UTI

A
  • Male sex
  • Older age
  • Symptoms >7 days
  • History of stone disease
  • Infection with drug-resistant organism
  • Recent hospitalization
  • Urinary tract instrumentation
  • Pregnancy
  • Diabetes
  • Functional/structural abnormalities
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9
Q

Pathology of UTI

A

Ascending infection vs. disseminated hematogenous spread (much less common)

Pathogenesis (ascending infection):
bacterial adhesion to the epithelium, followed by proliferation, invasion, and initiation of the inflammatory process

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10
Q

Prevalence of ascending infection is much more common in —– and why?

A

in women
because of the short urethra
compared to the male anatomy

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11
Q

Uncomplicated UTI microorganisms

A
  • Proteus,
  • E. coli (80%),
  • Klebsiella,
  • S. saprophyticus

PEKS

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12
Q

Complicated UTI microorganisms

A
  • E. coli,
  • Enterococci,
  • Pseudomonas,
  • S. epidermidis,
  • other GNR= Gram-negative rods
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13
Q

Catheter-associated UTI organisms

A
  • yeast (30%) (eg. candida)
  • E. coli,
  • S. epidermidis,
  • other GNR
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14
Q

Urethritis microorganisms

A
  • C. trachomatis,
  • N. gonorrhea,
  • Ureaplasma urealyticum,
  • T. vaginalis,
  • Mycoplasma. genitalium
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15
Q

S. aureus is associated with

A

with bacteremia and hematogenous seeding

uncommon primary instrumentation;

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16
Q

Clinical findings in cystitis

A
  • dysuria,
  • urgency,
  • frequency,
  • hematuria,
  • change of urine color,
  • cloudy urine,
  • foul-smelling urine,
  • suprapubic pain,
  • fever generally absent
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17
Q

is fever present in cystitis

A

No , fever generally absence

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18
Q

Clinical findings urethritis

A

Urethritis: similar to cystitis + urethral discharge

  • dysuria, urgency, frequency,
  • hematuria
  • change of urine color
  • cloudy urine
  • foul-smelling urine
  • suprapubic pain
  • fever generally absent
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19
Q

acute prostatitis clinical findings

A
  • perineal pain
  • fever
  • pain on DRE
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20
Q

CHRONIC prostatitis clinical findings

A

similar to cystitis (dysuria, urgency, frequency, hematuria, change of urine color, cloudy urine, foul-smelling
urine, suprapubic pain, fever generally absent)
+
symptoms of obstruction (hesitancy, waek stream)

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21
Q

Pyelonephritis clinical findings

A
  • fever, chills
  • flank/back pain,
  • nausea/vomiting/diarrhea,
  • progression to sepsis
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22
Q

Renal abscess clinical findings

A
  • identical to pyelonephritis (fever, skaing chills, flank/back pain, nausea/vomiting/diarrhea, progression to sepsis)
    +
  • persistent fever despite appropriate AB
23
Q

persistent fever despite appropriate AB gives suspicion of

A

renal abscess

24
Q

classic signs and symptoms of cystitis for clinical diagnosis

A
  • dysuria
  • urinary frequency
  • urgency
  • and/or suprapubic pain).
25
Q

For women presenting with atypical urinary symptoms, the
diagnosis is supported by

A
  • the presence of pyuria
  • and bacteriuria

on urinalysis and/or culture

26
Q

Diagnostics of UTI

A
  • Urinalysis: pyuria, bacteriuria, hematuria, nitrites
  • Urine dipstick:
    *WBC (leukocyte esterase activity)
    *nitrite (only Gram-),
    *urobilinogen
    *protein
    *pH, Hgb, ketones, glucose, bilirubin
  • Urine culture:
    *significant bacterial counts > 105 CFU/ml im asymptomatic women
    *>103 CFU/ml in men
    *>102 CFU/ml in catherized patient
  • Blood culture: if febrile and possibly complicated UTI
  • DNA detection (NAAT, PCR): suspected urethritis with C. trachomatous, N. gonorrhea
  • Abdominal and pelvic US: assess degree of renal parenchyma involvement in pyelonephritis
  • Abdominal CT: rule-out abscess in patients with pyelonephritis who fail to respond after 72 hrs
  • Urologic work-up (VUR investigation, urography): if recurrent UTIs
27
Q

what can be detected on urinalysis

A

Urinalysis:
1. pyuria,
2. bacteriuria,
3. hematuria,
4. nitrites

28
Q

what can urine dipstick show

A

Urine dipstick:
*WBC (leukocyte esterase activity)
*nitrite (only Gram-),
*urobilinogen
*protein
*pH
*Hgb,
*ketones, glucose,
*bilirubin

29
Q

urine culture significant bacterial counts in asymptomatic women, men, and in catherized pts

A
  • Urine culture:
    *significant bacterial counts
    > 105 CFU/ml im asymptomatic women
    >103 CFU/ml in men
    >102 CFU/ml in catherized patient
30
Q

When to take blood culture in patient with suspected UTI

A

if febrile and possibly complicated UTI

31
Q

DNA detection what methods are used and what microorganisms

A

DNA detection (NAAT, PCR):
* suspected urethritis with C. trachomatous, N. gonorrhea

NAAT = Nucleic acid amplification test

32
Q

How to assess degree of renal parenchyma involvement in pyelonephritis

A
  • Abdominal and pelvic US
33
Q

when to do abdominal CT in pts with pyelonephritis

A
  • Abdominal CT: r
    *rule-out abscess in patients with pyelonephritis who fail to respond after 72 hrs
34
Q

If pts suffers from recurrent UTI what diagnostic method is used to assess

A
  • Urologic work-up (VUR investigation, urography): if recurrent UTIs
35
Q

what is indicated for all symptomatic UTIs

A

antimicrobial therapy

36
Q

choice of antimicrobial agent, dose and
duration of therapy depend on

A
  • the site of infection and
  • the presence or absence of complicating conditions
37
Q

Noncomplicated
cystitis treatment and how long for

A

Monotherapy with one of the following (3-5 days)
- Fosfomycin (3 g PO single dose)
- Nitrofurantoin (PO 3-5 days) Urinary antiseptic rapidly excreted into urine and acts to suppress bacteria, no systemic effect
- TMP-SMX
- Amoxicillin/clavulanate
- Ciprofloxacin/levofloxacin (check local resistance pattern)

38
Q

Complicated
cystitis treatment
how long is the treatment

A

Monotherapy with either one of the above agents for 10-14 days

Fosfomycin (3 g PO single dose)
- Nitrofurantoin (PO 3-5 days)
- TMP-SMX
- Amoxicillin/clavulanate
- Ciprofloxacin/levofloxacin (check local resistance pattern

note- same as in catheterized patient

39
Q

Catheterized
patient treatment and how long for

A

Monotherapy with either one of the above agents for 10-14 days + remove/change catheter

  • Fosfomycin (3 g PO single dose)
  • Nitrofurantoin (PO 3-5 days)
  • TMP-SMX
  • Amoxicillin/clavulanate
  • Ciprofloxacin/levofloxacin (check local resistance pattern
40
Q

Urethritis treatment

A
  • Neisseria coverage:
    -ceftriaxone (IM, 250 mg single dose)
    -OR spectinomycin (IM, 2 g single dose)
    -OR azithromycin (PO, 1 g single dose)
  • Chlamydia coverage:
    -azithromycin (PO, 1 g single dose)
    -OR doxycycline (PO, 100 mg, twice daily x 7 days)
41
Q

what antibiotics cover neisseia

A

-ceftriaxone (IM, 250 mg single dose)
-OR spectinomycin (IM, 2 g single dose)
-OR azithromycin (PO, 1 g single dose)

42
Q

what antibiotics cover chlamydia

A
  • Chlamydia coverage:

-azithromycin (PO, 1 g single dose)
-OR doxycycline (PO, 100 mg, twice daily x 7 days)

43
Q

Prostatitis treatment and for how long (Acute VS chronic)

A

Monotherapy with either one of the following:
(14-28 days for acute; 6-12 months for chronic)
- TMP-SMX
- Ciprofloxacin/levofloxacin

44
Q

Treating chronic prostatitis what to take into count

A
  • choose a drug with high prostate penetration ability.
  • During the acute phase, local inflammation makes it easier for most agents to penetrate the gland
    (thus, it’s not a crucial issue to be addressed acutely
45
Q

Pyelonephritis outpatient treatment

A

Outpatient (x14days) :
ciprofloxacin/levofloxacin
OR amoxicillin/clavulanate
OR cefepime

46
Q

pyelonephritis inpatient treatment

A

Inpatient :
ceftriaxone
OR piperacillin/tazobactam
OR imipenem (start IV, change to PO when patient improves clinically and is afebrile; then complete 14 days course

47
Q

Renal abscess treatment

A

Drainage + AB as for pyelonephritis

(pyelonephritis Outpatient: ciprofloxacin/levofloxacin OR amoxicillin/clavulanate OR cefepime

Inpatient : ceftriaxone OR piperacillin/tazobactam OR imipenem (start IV, change to PO when patient improves clinically and is afebrile; then complete 14 days course))

48
Q

Obstructive
pyelonephritis treatment

A
  1. AB, antipyretics, fluids
  2. Urine deviation (percutaneous nephrostomy of Double-J stent)
  3. Relieving obstructive cause (eg. stone removal
49
Q

Specific forms of pyelonephritis

A
  • Chronic pyelonephritis
  • Xanthogranulomatous pyelonephritis
50
Q

Chronic pyelonephritis develops based on

A

recurrent
or
inadequately-treated acute episodes

51
Q

Chronic pyelonephriti associated with

A

anatomic/functional condition predisposing to recurrent infections (stone disease, VUR).

52
Q

Chronic pyelonephritis on imaging

A

Asymmetric atrophic kidney on imaging; ‘kidney thyroidization’ (eosinophilic nodules which
resemble thyroid gland tissue architecture).

53
Q

Xanthogranulomatous pyelonephritis what is it

A

is a rare form of kidney infection (usually Proteus

54
Q

Xanthogranulomatous pyelonephritis causes ?

A
  • extensive kidney damage due to progressive granulomatous inflammation of the parenchyma;
  • gross nodules may resemble tumors

Urology (30 decks)

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