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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
Q

dipstick UA findings

A

leukocyte esterase + indicates presence of 5-15 WBC/hpf

nitrite + indicates presence of bacteria that convert nitrates > nitrites

26
Q

urine microscopy findings

A

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
Q

quantitative urine culture findings

A

obtain in patients you suspect have pyelonephritis, recurrent UTI, or complicated UTI
10^2-10^5 CFU/mL is considered diagnostic for UTI

28
Q

primary treatments for uncomplicated cystitis

A

nitrofurantoin 100 mg BID x 5 days
TMP/SMX DS BID x 3 days
fosfomycin 3 g x 1 dose

29
Q

alternative treatments for uncomplicated cystitis

A

ciprofloxacin or levofloxacin x 3 days

B-lactams x 3-7 days

30
Q

indications for admission

A

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
Q

indications for imaging

A 
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
Q

treatment for uncomplicated pyelonephritis

A

fluoroquinolones x 7 days
TMP/SMX DS BID x 14 days
oral b-lactam x 14 days

33
Q

why can you not use nitrofurantoin for pyelonephritis

A

BAD TISSUE PENETRATION

34
Q

definition of recurrent UTI

A

3 UTIs within 12 mo or 2 UTIs within 6 mo

35
Q

what do you focus on with patients with recurrent UTIs

A 
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
Q

evaluation of a patient with recurrent UTI

A

pelvic exam to check for urethral diverticulum, atrophic vaginitis
urine cultures mandatory
upper tract imaging usually completed
+/- cystoscopy depending on risk factors

37
Q

behavioral counseling for recurrent UTI prevention

A 
discontinue use of spermacide and/or diaphragm
avoid douching
post coital voiding
timed/double voiding
constipation management
38
Q

biological mediators for recurrent UTI prevention

A

cranberry juice, capsules or tablets

39
Q

topical estrogen in recurrent UTI prevention

A

mainstay of treatment in postmenopausal women with atophic vaginitis

40
Q

adhesion blockers in recurrent UTI prevention

A

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
Q

antibiotic options in recurrent UTI prevention

A

self-start: have prescription at home just in case
suppressive
post-coital: low dose after sex, if sex is a risk factor

42
Q

risk factors for recurrent UTI in postmenopausal women

A 
low E
incomplete bladder emptying
incontinence
prolapse
diabetes
43
Q

prevention of recurrent UTI in postmenopausal women

A

increase fluid intake
improve perineal hygiene
vaginal estrogen

44
Q

characteristics of UTI during pregnancy

A

always considered COMPLICATED
17-20% of pregnancies
urine culture mandatory

45
Q

when would you give a pregnant woman supressive abx

A

1 episode of pyelonephritis or 2 episodes of cystitis during pregnancy
give a low dose to reduce the risk of preterm labor

46
Q

treatment of pyelonephritis in pregnancy

A

hospitalization and IV abx

47
Q

asymptomatic bacteriuria in pregnancy

A

screen at inital prenatal visit
ALWAYS TREAT; reduced morbidity and complications
2-10% incidence

48
Q

risks of asymptomatic bacteriuria in pregnancy

A

preterm rupture of membranes
preterm labor
chorioamnioitis
postpartum fever

49
Q

acute pyelonephritis during pregnancy

A 
increased risk during pregnancy
maternal risks:
septic shock
resp and renal insufficiency
fluid balance disorders
death
50
Q

what abx can you use during pregnancy

A

penicillin
cephalosporin
nitrofurantoin
fosfomycin

51
Q

AVOID DURING PREGNANCY

A

fluoroquinolones: cartilage development issues
chloramphenicol: gray baby syndrome
trimethoprim: folate antagonism
erythromycin: maternal cholestatic jaundice
tetracyclines: fetal bones/teeth, maternal liver

52
Q

prevalence of asymptomatic bacteriuria

A 
2-5% of adult women
7-9% of diabetic women
25-50% of elderly institutionalized
50% SCI
100% chronic indwelling foley catheter
53
Q

when is there and indication to screen for or treat asymptomatic bacteriuria

A

pregnant women

persons scheduled for GU instrumentation

54
Q

staghorn calculus

A

renal stone comprising most of the collecting system
majority are struvite (magnesium ammonium phosphate)
lead to recurrent UTIs, urosepsis, renal functional deterioration

55
Q

struvite stones

A

caused by bacteria that produce urease

-leads to a more alkaline pH which allows for rapid formation of struvite stones

56
Q

urease producing bacteria

A 
proteus
enterobacter
morganella
serratia
klebsiella
57
Q

treatment of complicated UTI

A

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
Q

abx options in complicated UTI

A 
IV fluoro
aminoglycosides +/- ampicillin
3rd generation cephalosporin
extended spectrum penicillin
carbapenem

RDS Test 3 (15 decks)

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