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RDS Test 3 > B8.046 Urinary Tract Infections in Females > Flashcards

B8.046 Urinary Tract Infections in Females Flashcards

1
Q

lower UTI

A

cystitis, urethritis, prostatitis

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2
Q

upper UTI

A

pyelonephritis, intra-renal abscess, perinephric abscess

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3
Q

cystitis

A

clinical syndrome of inflammation or infection of the urinary bladder

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4
Q

uncomplicated UTI

A

infection in healthy patient (female) with functionally normal urinary tract

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5
Q

complicated UTI

A

infection associated with anatomic/functional abnormality of the urinary tract, immunocompromised host, or multi drug resistant bacteria
also UTIs in males

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6
Q

pyelonephritis

A

infection of kidney that tends to arise from an ascending UTI (fever, flank pain)

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7
Q

asymptomatic bacteriuria

A

2 consecutive clean catch midstream urine samples growing 10^5 CFU isolation of same bacterial strain in the absence of symptoms

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8
Q

characteristics of uncomplicated UTIs

A 
normal urinary tract both functionally and structurally
majority are healthy women
sexually active
community acquired
respond to therapy
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9
Q

characteristics of complicated UTIs

A 
structural or functional voiding abnormalities
urinary tract obstruction
male
pregnancy
diabetes mellitus
immunosuppression 
childhood UTIs
recent antimicrobial use
indwelling catheter
urinary tract instrumentation
nosocomial UTI
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10
Q

epidemiology of UTIs

A

50% of all women, 12% of all men in their lifetime

within 6 mo of initial, 20% of women will have a recurrence

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11
Q

genetic risk factors for UTI

A

immune receptor polymorphisms
urothelial receptor density
family history

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12
Q

biological/physiological risk factors for UTI

A 
anatomic factors
vaginal factors/hormonal status
urinary obstruction
urinary stasis
urolithiasis
immunocompromised
pregnancy
SCI
catheterization
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13
Q

behavioral risk factors for UTI

A

functional stasis
sexual intercourse
birth control practices (spermacide/diaphragm)

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14
Q

how does hormonal status impact UTI risk

A

postmenopausal women experience more vaginal atrophy
lactobacilli stop growing due to changes in pH, allows e.coli to grow more easily
give vaginal E to prevent this

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15
Q

common causative pathogens in adult UTIs

A 
e.coli (80%)
klebsiella, enterobacter
proteus
pseudomonas
staph sapro (5-15%)
enterococcus
candida
adenovirus type 11
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16
Q

normal perineal flora

A 
lactobacillus
corynebacteria
staphylococcus
streptococcus
anaerobes
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17
Q

ascending route theory

A

spread is via ascention of urinary tract, not by hematogenous or lymphatic spread

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18
Q

things that contribute to ascension

A

reduced urine flow
factors that promote colonization
facilitation of ascent
bacterial factors

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19
Q

bacterial factors that aid in pathogenesis of uropathogenic e.coli

A

bacterial adhesions

phase variation

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20
Q

bacterial adhesions

A

type 1 pili: mediate binding of uroplakins, mannosylated glycoproteins on the surface of uroepithelial cells (bladder binding)
P pili: bind to galactose dissacharide on the surface of uroepithelial cells and P blood group antigen on RBCs (kidney binding)

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21
Q

phase variation

A

type 1 pili increase susceptibility to phagocytosis, P pili block phagocytosis
type 1 down regulated , type P upregulated in strains that cause pyelonephritis

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22
Q

clinical signs of cystitis

A

new onset urinary frequency + dysuria without vaginal discharge is diagnostic (PPV 90%)
+/- urgency, suprapubic pain, hematuria

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23
Q

clinical signs of pyelonephritis

A

fever, chills, flank pain

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24
Q

urine testing procedure in UTI

A

midstream, clean catch
UA
urine culture + sensitivities (not necessary if uncomplicated)

25
dipstick UA findings
leukocyte esterase + indicates presence of 5-15 WBC/hpf | nitrite + indicates presence of bacteria that convert nitrates > nitrites
26
urine microscopy findings
lots of squamous cells = bad specimen pyuria (>10 WBCs/hpf) is most sensitive for UTI bacteria count 5/hpf WBC casts sensitive for pyelonephritis
27
quantitative urine culture findings
obtain in patients you suspect have pyelonephritis, recurrent UTI, or complicated UTI 10^2-10^5 CFU/mL is considered diagnostic for UTI
28
primary treatments for uncomplicated cystitis
nitrofurantoin 100 mg BID x 5 days TMP/SMX DS BID x 3 days fosfomycin 3 g x 1 dose
29
alternative treatments for uncomplicated cystitis
ciprofloxacin or levofloxacin x 3 days | B-lactams x 3-7 days
30
indications for admission
if a patient appears toxic (fever, tachy, hypotensive) UTI in context of obstruction (stone) is a urologic emergency inability to tolerate oral hydration complicating comorbidities immunocompromised state elderly/disabled
31
indications for imaging
``` complicated UTI persistence of hematuria after infection treated sepsis from urinary source history of urolithiasis neurogenic bladder poor response to therapy infections with urea-splitting bacteria recurrence with the same or unusual strain ```
32
treatment for uncomplicated pyelonephritis
fluoroquinolones x 7 days TMP/SMX DS BID x 14 days oral b-lactam x 14 days
33
why can you not use nitrofurantoin for pyelonephritis
BAD TISSUE PENETRATION
34
definition of recurrent UTI
3 UTIs within 12 mo or 2 UTIs within 6 mo
35
what do you focus on with patients with recurrent UTIs
``` prevention look at: relationship to sex sexual practices history of childhood UTIs history of voiding dysfunction/constipation history of stones history of anatomic abnormalities ```
36
evaluation of a patient with recurrent UTI
pelvic exam to check for urethral diverticulum, atrophic vaginitis urine cultures mandatory upper tract imaging usually completed +/- cystoscopy depending on risk factors
37
behavioral counseling for recurrent UTI prevention
``` discontinue use of spermacide and/or diaphragm avoid douching post coital voiding timed/double voiding constipation management ```
38
biological mediators for recurrent UTI prevention
cranberry juice, capsules or tablets
39
topical estrogen in recurrent UTI prevention
mainstay of treatment in postmenopausal women with atophic vaginitis
40
adhesion blockers in recurrent UTI prevention
D-mannose e. coli adhese to mannosylated receptors in the urothelium by means of FimH adhesion located on type 1 pili; theoretically blocked by D-mannose
41
antibiotic options in recurrent UTI prevention
self-start: have prescription at home just in case suppressive post-coital: low dose after sex, if sex is a risk factor
42
risk factors for recurrent UTI in postmenopausal women
``` low E incomplete bladder emptying incontinence prolapse diabetes ```
43
prevention of recurrent UTI in postmenopausal women
increase fluid intake improve perineal hygiene vaginal estrogen
44
characteristics of UTI during pregnancy
always considered COMPLICATED 17-20% of pregnancies urine culture mandatory
45
when would you give a pregnant woman supressive abx
1 episode of pyelonephritis or 2 episodes of cystitis during pregnancy give a low dose to reduce the risk of preterm labor
46
treatment of pyelonephritis in pregnancy
hospitalization and IV abx
47
asymptomatic bacteriuria in pregnancy
screen at inital prenatal visit ALWAYS TREAT; reduced morbidity and complications 2-10% incidence
48
risks of asymptomatic bacteriuria in pregnancy
preterm rupture of membranes preterm labor chorioamnioitis postpartum fever
49
acute pyelonephritis during pregnancy
``` increased risk during pregnancy maternal risks: septic shock resp and renal insufficiency fluid balance disorders death ```
50
what abx can you use during pregnancy
penicillin cephalosporin nitrofurantoin fosfomycin
51
AVOID DURING PREGNANCY
fluoroquinolones: cartilage development issues chloramphenicol: gray baby syndrome trimethoprim: folate antagonism erythromycin: maternal cholestatic jaundice tetracyclines: fetal bones/teeth, maternal liver
52
prevalence of asymptomatic bacteriuria
``` 2-5% of adult women 7-9% of diabetic women 25-50% of elderly institutionalized 50% SCI 100% chronic indwelling foley catheter ```
53
when is there and indication to screen for or treat asymptomatic bacteriuria
pregnant women | persons scheduled for GU instrumentation
54
staghorn calculus
renal stone comprising most of the collecting system majority are struvite (magnesium ammonium phosphate) lead to recurrent UTIs, urosepsis, renal functional deterioration
55
struvite stones
caused by bacteria that produce urease | -leads to a more alkaline pH which allows for rapid formation of struvite stones
56
urease producing bacteria
``` proteus enterobacter morganella serratia klebsiella ```
57
treatment of complicated UTI
urine culture MANDATORY duration of treatment 7-14 days broad spectrum abx and adjusted according to culture results switch to oral therapy at 48 hrs after clinically well
58
abx options in complicated UTI
``` IV fluoro aminoglycosides +/- ampicillin 3rd generation cephalosporin extended spectrum penicillin carbapenem ```

RDS Test 3 (15 decks)

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