cystitis Flashcards
what is cystitis?
urinary infx involving the bladder
bladder infx, UTI, lower UTI
Risk factors for cystitis?
- 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
what are non-factors for cystitis?
Voiding after intercourse Wiping from front to back Tight clothing Voiding as soon feel urge to void Hot tubs Douches Tampons
presentation of cystitis?
Irritative voiding symptoms (dysuria, urgency, frequency)
Suprapubic discomfort
Cloudy, malodorous urine
Fever
Mental status change
SCI: Autonomic dysreflexia, incr muscle spasticity
how do you dx cystitis?
UA: *Leukocyte esterase positive *Nitrite positive Pyuria > 5 WBC/hpf Bacteria
urine culture: >100,000 organisms, monoculture
pathogens seen w/cystitis
MC = E. coli
Others:
Klebsiella, Enterobacter, Proteus, Pseudomonas, Staphylococcus saprophyticus, Enterococcus, Candida
Normal perineal flora usu. NOT the cause of cystitis
Lactobacillus, Corynebacterium, Streptococcus, Staphylococcus epidermidis
What can make the pathogen more virulent?
pili = Bacterial adhesion to human epithelial cells
Tx for cystitis
TMP/SMZ DS bid x 3 day
Nitrofurantoin 100 mg bid (5 to) 7 day
what med should you not give if suspicious for pyelonephritis?
Nitrofurantoin (Macrodantin, Macrobid)
Long term use assoc. pulmonary fibrosis in elderly
which meds are effective against enterococcus?
Ampicillin and amoxicillin
Which Beta-lactamase inhibitors can be used to tx cystitis?
Clavulanic acid (combined w/ amoxicillin in Augmentin)
Sulbactam (combined w/ ampicillin in Unasyn)
Tazobactam (combined w/ piperacillin in Zosyn)
which meds have a beta-lactam ring?
Penicillins, cephalosporins
Can fluroquinolones be used to tx cystitis?
NOT as first line. Not rec by IDSA for cystitis
3day tx
SE’s: tendinitis, tendon rupture
Can you Rx empiric tx for cystitis?
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)
what if sxs post tx?
Ensure compliance Re-culture Check PVR Pelvic (vaginitis) diet quercetin 500 mg po bid constipation stress prevent re-infx's
How can you tx symptomatically for urgency, dysuria, pelvic pain?
urgency - antimuscarinics
dysuria - phenazopyridine
pelvic pain - NSAIDs
what are ways you can prevent re-infx?
Avoid spermicides/diaphragm
Topical vaginal estrogen
Consider antibiotic prophylaxis
Self-start antibiotic therapy
How does topical vaginal estrogen work?
Normalizes vaginal flora, restores Lactobacilli
Decreases vaginal pH
when is topical vaginal estrogen for prevention of cystitis contraindicated?
if h/o VTE, PE, CVA, MI, estrogen dependent malignancy, undiagnosed and genital bleed, liver dysfunction
what would indicate a complicated cystitis?
Immunosuppression Pregnancy Male Pediatric Indwelling urinary catheter/stent Anatomic abnormality (calyceal diverticulum) Urinary obstruction Urolithiasis Renal insufficiency
Difference between colonization and infx in presence of catheter?
Bacteruria/ colonization doesn’t equal infection
Bacteria can form biofilm on catheter
Biofilm=sheet of bacteria encased in extracellular matrix
Biofilm resistant to antibiotics
what if pt has cystitis in presence of chronic indwelling catheter?
might have MS changes
Remove catheter (to remove biofilm)
Replace catheter and obtain urine culture
Antibiotics
Prevention of UTI’s for
Chronic indwelling catheter
Sterile technique
keep system closed
Do not allow urine in drainage bag to backflow to bladder
Change catheter periodically
Keep bag below bladder level
