cystitis

Question 1

what is cystitis?

Answer 1

urinary infx involving the bladder

bladder infx, UTI, lower UTI

Question 2

Risk factors for cystitis?

Answer 2

• Immunocompromise
• Urinary stasis/obstruction (urethral obstruction, urinary retention, vesicoureteral reflux, bladder diverticulum)
• Congenital GU abn
• Sexual activity
• Spermicide use
• Diaphragm use
• Urinary incontinence
• Cystocele or pelvic prolapse

Question 3

what are non-factors for cystitis?

Answer 3

Voiding after intercourse
Wiping from front to back
Tight clothing
Voiding as soon feel urge to void
Hot tubs
Douches
Tampons

Question 4

presentation of cystitis?

Answer 4

Irritative voiding symptoms (dysuria, urgency, frequency)

Suprapubic discomfort

Cloudy, malodorous urine

Fever

Mental status change

SCI: Autonomic dysreflexia, incr muscle spasticity

Question 5

how do you dx cystitis?

Answer 5

UA: 
*Leukocyte esterase positive 
*Nitrite positive  
Pyuria > 5 WBC/hpf
Bacteria

urine culture: >100,000 organisms, monoculture

Question 6

pathogens seen w/cystitis

Answer 6

MC = E. coli

Others:
Klebsiella, Enterobacter, Proteus, Pseudomonas, Staphylococcus saprophyticus, Enterococcus, Candida

Question 7

Normal perineal flora usu. NOT the cause of cystitis

Answer 7

Lactobacillus, Corynebacterium, Streptococcus, Staphylococcus epidermidis

Question 8

What can make the pathogen more virulent?

Answer 8

pili = Bacterial adhesion to human epithelial cells

Question 9

Tx for cystitis

Answer 9

TMP/SMZ DS bid x 3 day

Nitrofurantoin 100 mg bid (5 to) 7 day

Question 10

what med should you not give if suspicious for pyelonephritis?

Answer 10

Nitrofurantoin (Macrodantin, Macrobid)

Long term use assoc. pulmonary fibrosis in elderly

Question 11

which meds are effective against enterococcus?

Answer 11

Ampicillin and amoxicillin

Question 12

Which Beta-lactamase inhibitors can be used to tx cystitis?

Answer 12

Clavulanic acid (combined w/ amoxicillin in Augmentin)

Sulbactam (combined w/ ampicillin in Unasyn)

Tazobactam (combined w/ piperacillin in Zosyn)

Question 13

which meds have a beta-lactam ring?

Answer 13

Penicillins, cephalosporins

Question 14

Can fluroquinolones be used to tx cystitis?

Answer 14

NOT as first line. Not rec by IDSA for cystitis

3day tx

SE’s: tendinitis, tendon rupture

Question 15

Can you Rx empiric tx for cystitis?

Answer 15

Not amoxicillin, ampicillin, or FQ

Nitrofurantoin 100 mg bid

SMX/TMP DS bid if less than 20% resistance locally

Fosfomycin 3gm po x1 dose

Amox-clav (beta-lactamase activity)

Cefdinir (Omnicef)

Cefaclor (Ceclor)

Cefpodoxime proxetil (Vantin)

Question 16

what if sxs post tx?

Answer 16

Ensure compliance
Re-culture
Check PVR
Pelvic (vaginitis)
diet
quercetin 500 mg po bid
constipation
stress
prevent re-infx's

Question 17

How can you tx symptomatically for urgency, dysuria, pelvic pain?

Answer 17

urgency - antimuscarinics
dysuria - phenazopyridine
pelvic pain - NSAIDs

Question 18

what are ways you can prevent re-infx?

Answer 18

Avoid spermicides/diaphragm

Topical vaginal estrogen

Consider antibiotic prophylaxis

Self-start antibiotic therapy

Question 19

How does topical vaginal estrogen work?

Answer 19

Normalizes vaginal flora, restores Lactobacilli

Decreases vaginal pH

Question 20

when is topical vaginal estrogen for prevention of cystitis contraindicated?

Answer 20

if h/o VTE, PE, CVA, MI, estrogen dependent malignancy, undiagnosed and genital bleed, liver dysfunction

Question 21

what would indicate a complicated cystitis?

Answer 21

Immunosuppression
Pregnancy
Male
Pediatric
Indwelling urinary catheter/stent
Anatomic abnormality (calyceal diverticulum)
Urinary obstruction
Urolithiasis
Renal insufficiency

Question 22

Difference between colonization and infx in presence of catheter?

Answer 22

Bacteruria/ colonization doesn’t equal infection

Bacteria can form biofilm on catheter

Biofilm=sheet of bacteria encased in extracellular matrix

Biofilm resistant to antibiotics

Question 23

what if pt has cystitis in presence of chronic indwelling catheter?

Answer 23

might have MS changes

Remove catheter (to remove biofilm)

Replace catheter and obtain urine culture

Antibiotics

Question 24

Prevention of UTI’s for

Chronic indwelling catheter

Answer 24

Sterile technique

keep system closed

Do not allow urine in drainage bag to backflow to bladder

Change catheter periodically

Keep bag below bladder level

Question 25

when giving nitrofurantoin which lab test should you order?

Answer 25

Creatinine