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Summer FDTN Exam 1 > Cystitis and Pyelonephritis > Flashcards

Cystitis and Pyelonephritis Flashcards

1
Q

What is Cystitis

A

urinary infection involving the bladder

“lower UTI”

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2
Q

Who is at risk for cystitis

A 
Immunocompromised (DM, HIV, CA, steroids, chemo, malntr) 
Urinary stasis (retention, obstruction, bladder diverticulum) 
Congenital abn
Sexual activity 
Spermicide use
Diaphragm use 
Incontinence 
Pelvic prolapse 
Cystocele
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3
Q

What are the MC Sx of cystitis (aka irritative voiding Sx)

A

dysuria (burning)
urgency
frequency

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4
Q

Other Sx of cystits include

A 
Suprapubic discomfort 
cloudy, stinky urine 
fever
mental status changes 
SCI (ANS dysreflexia, increased muscle spasticity)
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5
Q

What will a UA for cystitis show

A 
Dipstick: Leukocyte esterase, Nitrites (unless strep) 
MicroscopyL Pyuria (WBC>5), bacteria
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6
Q

What will a urine culture for cystitis show

A

> 100,000 organisms, monoculture (only 1 type of organism)

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7
Q

What pathogens cause cystitis

A

**E. Coli!
Klebsiella, enterobacter, proteus, pseudomonas, candida, staph saprophyticus, etc.
Pathogens have pili which allow bacteria to stick to us better (more virulent)

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8
Q

What pathogens are part of the normal flora and not likely the cause of cystitis

A

Lactobacillus, corynebacterium, strep, staph epidermidis

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9
Q

What are preferred treatments of Cystitis

A

Bactrim (or septra) BID x 3 days

Macrobid BID x 7 days (dont use long term, risk for pulmonary fibrosis- also NOT for pyelonephritis)

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10
Q

What antibiotic is effective against Enterococcus

A

Ampicillin

Amoxicillin

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11
Q

Which antibiotics are beta-lactamase inhibitors

A

Clavulanic acid (+ augmentin makes Augmentin)
Sulbactam (+ ampicillin makes Unasyn)
Tazobactam (+ piperacillin makes Zosyn)

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12
Q

What antibiotics are not preferred for cystits 2/2 ADE

A

Fluoroquinolones (Cipro, Levo) x 3 days
Can cause tendonitis and tendon rupture (advise NO weight lifting)
must be 16+ y/o!

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13
Q

What lab must you check if you prescribe Macrobid

A

Creatinine! Macrobid is cleared renally

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14
Q

What other abx can be used for empiric Tx of cystitis

A 
Fosfomycin (powder) PO single dose (not for pyelo) 
Cefdinir
Augmentin
Ceclor
Vantin
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15
Q

What should you do if cystitis Sx persist s/p tx

A

ensure compliance
re-culture
check PVR
Pelvic (vaginitis?)

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16
Q

What meds can you give for persistent Sx

A 
Urgency: Antimuscarinic 
Dysuria: Phenazopyridine 
Pelvic pain: NSAIDS 
Can also give Quercetin (decrease inflammation)
Treat constipation and stress
17
Q

How can you prevent reinfection s/p treating cystitis

A

Avoid spermicides/diaphragm
Topical vaginal estrogen (normalize flora, restore lactobacilli, and decrease vaginal pH
-Use high caution with: antibiotic prophylaxis and self-start abx therapy

18
Q

What causes complicated cystitis

A 
Immunosuppression 
pregnancy 
male 
peds
indwelling catheter 
anatomic abn (diverticulum, etc) 
urinary obstruction 
urolithiasis 
renal insufficiency
19
Q

Why can complicated cystitis occur in the presence of a catheter

A

Bacteria can colonize and form a biofilm on the catheter

biofilm is resistant to abx

20
Q

What should you do if a patient with an indwelling catheter has UTI Sx

A

remove catheter (remove biofilm)
replace catheter
give abx

21
Q

How can you prevent UTI’s in patients with indwelling cath

A

sterile technique when placing catheter
keep system closed
dont let urine back flow from bag to bladder
keep bag BELOW bladder level
dont kink tubing
remove cath as soon as it is no longer necessary

22
Q

What is pyelonephritis

A

Urinary infection involving renal parenchyma

“upper UTI”

23
Q

What are symptoms of pyelonephritis

A

Fever, chills, flank pain, abdominal pain, N/V
If ascending from bladder, urinary Sx (dysuria, frequency, urgency)
If hematogenous spread, no urinary Sx

24
Q

What will you see on PE for pyelonephritis

A

Fever

CVA ttp

25
Q

What will labs for pyelonephritis show

A

UA: WBC, WBC casts
CBC: leukocytosis w/ left shift
Urine culture
Blood culture may be negative

26
Q

When would you get imaging in a patient suspected of pyelonephritis

A

If very ill, unstable, septic, or with DM

immunocompromised, unresponsive to abx, etc.

27
Q

What imaging can be done to evaluate pyelonephritis

A 
CT Urogram (perinephric stranding, large kidneys, dilated collecting system) 
Renal US (large kidneys, abn echogenicity)
28
Q

How do you treat pyelonephritis if patient is mildly ill

A

Outpatient Fluoroquinolone x 7 days (or other abx x 14 days)
Initial long acting IV Ceftriaxone
Admit if still febrile >72 hours

29
Q

How do you treat pyelonephritis in moderately or severely ill patients

A 
Admit! 
Urine and blood cultures
IV Fluoroquinolone, aminoglycoside, carbapenem, or cephalosporin- switch to PO when afebrile x 24-48 hrs 
Imaging for renal abscess
D/C home w/ 2 weeks po abx
30
Q

What is the spectrum of pyelonephritis

A

Pyelonephritis –> acute bacterial nephritis –> renal abscess
Suspect the latter 2 if patient is not improving

31
Q

What is Acute Bacterial Nephritis

A

Bacterial interstitial nephritis of the renal cortex–> renal mass (NO liquefaction)

32
Q

What is a renal abscess

A

Purulent fluid collecting in the kidney (often DM or immunocompromised)
MCC is gram NEGATIVE bacteria (unless hematogenous route, then gram + like staph aureus)

33
Q

How do you treat a renal abscess

A

IV abx
Percutaneous drainage
surgical drainage

34
Q

What is chronic pyelonephritis

A

Scarred, atrophic, poor functioning kidney 2/2 prior infections
Low flow and high renin
(renin= high angiotensin= high aldosterone= water/Na retention)

35
Q

How does chronic pyelonephritis present

A 
HTN 
Anemia 
Proteinuria 
Renal insufficiency 
Recurrent UTI 
Claceal blunting on imaging**
36
Q

How do you treat chronic pyelonephritis

A

Manage UTI RF
control HTN
Nephrectomy

Summer FDTN Exam 1 (12 decks)

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