Dysuria Flashcards
What are the red flag symptoms for upper urinary tract infection?
Need 3 –
- Male / Infant / Geriatric
- 7 days+
- Immunosuppressed
- Pyelonephritis in the past year
- Known abnormal anatomy
- DM
- Fever
- Flank Pain or Tenderness
What are positive predictors of UTI in young females?
Dysuria + Malodorous urine / Cloudy
– NOT MALES or ELDERLY
Why is the sensativity of UA low for Nitrites?
- Pseudomonas does not produce nitrite, nor do gram-positive bacteria
- Takes E.Coli and other gram-negatives several hours in contact with urine to make measurable nitrites
- Certain diets dont have many nitrates present to be converted into nitrites
What two UA components are best for evaluating for UTI?
Nitrites and Leukoesterase
+ WBC per high power field
+ Clinical likelihood
When are urine cultures most cost effective?
NOT IN YOUNG WOMEN
– Children, Men, Older women, and younger women with likelihood of upper urinary tract infection.
How many days of antibiotics are needed for uncompicated UTIs?
Only 3 days. Same cure rate as 7-10 days, if has risk factors for occult pylenonephritis, then 7 days it is.
What are the best choices for upper urinary tract infections in women?
TMP/SMX and Fluoroquinolones
— NOT Nitrofurantoin – (Macrobid)
How do you manage recurrent UTIs in a female?
– Culture, to ensure proper coverage for Abx for cure
ensures that if there is another cause of the dysuria the patient is not receiving abx without reason.
– Daily cranberry juice consumption
– Advise behavior changes
A 28 year old female is diagnosed with upper urinary tract infection, dysuria, fever, flank pain; she does not have any nausea and is able to keep down fluids without difficulty. What should be the management plan?
Outpatient management. She is stable, able to keep fluids down.
– Ceftriaxone, as loading dose
– oral abx for 14 days
+ Urine Cultures
When does a patient with pyelonephritis need to be admitted?
- Unable to take oral medications
- unstable vital signs
- obstructed / abscess in kidneys
++ Start Zosyn
If a healthy man comes into the clinic complaining of dysuria and increased urinary frequency. What is the first step in management?
Pre-Treatment Blood Cultures
- Most likely the infection is complicated, compared to a female UTI
- After 2x times of UTI they need imaging to look for abnormalities or nephrolithiasis
If an elderly women gets a UTI after just being treated for one, what is the next step?
Instead of the initial 3 day course, need 14 days Abx course, based on culture results
When should you suspect a UTI in a child?
- Unexplained Fever
- late-onset jaundice, poor weight gain, irritability
- diarrhea, vomiting, failure to gain weight
- suprapubic tenderness
School Age – back pain, abd pain, incontinence
How are children over the age of 3 months treated for a UTI? What is not used?
3 days treatment
- TMP/SMX, Augmentin, Macrobid
- **NO Fluoroquinolones = tendon rupture
How long can a urinary catheter stay in before needing to be replaced?
2 weeks
- increased risk for UTIs
