Exam 3- Genitourinary Infections Flashcards
What are the 5 types of genitourinary infections?
Pyelonephritis (kidney)
Cystitis (uncomplicated uti, bladder)
Urethritis (sti)
Prostatitis
Epididymitis (sti)
What are the 6 factors that make a UTI complicated?
Anatomical abnormality of urinary tract
Recent urologic procedure or instrumentation
Immunocompromised patients
Recurrent infections despite appropriate treatment
Males
UTI in pregnancy
What is an uncomplicated uti?
Patient who does not meet complicated uti criteria
Pre-menopausal women with normal anatomy
What are the most common pathogens found in genitourinary infections?
E. COLI***
What are the signs/symptoms of a UTI?
Dysuria (pain with urination)
Increased Urgency
Increased Frequency
Suprapubic “heaviness” and/or pain
Foul smelling/turbid urine
Hematuria
What are the signs/symptoms of pyelonephritis?
Normal UTI symptoms plus:
-Systemic signs of infection (fever, chills, rigors, nausea, vomiting, diarrhea)
-Flank pain (costovertebral angle [CVA] tenderness) (palpating over the last rib can be very painful)
What additional symptoms may be present with a complicated uti?
Symptoms may be atypical and non-specific:
Classic symptoms may or may not be present.
Also:
-Fever
-Malaise
-Altered mental status
-Urinary incontinence
-Change in appetite
What symptoms may be present with catheter-associated uti?
Classic symptoms are often not present
-Pain over kidney + bladder
-Fever
-Lethargy and malaise
What is the diagnostic criteria for uti/pyelonephritis?
Symptoms present
+
>/= 10^5 of >/= 1 bacterial species from a clean void
OR
> /= 10^3 of >/= 1 bacterial species from a catheter (placed in last 48-hr)
What 2 tests can we perform to diagnose uti/pyelonephritis?
Urinalysis
Urine culture
*do both
What are the 4 key components of a urinalysis relating to a UTI?
Bacteria present
WBC present (>/= 10 cells/hpf)
Leukocyte esterase present
Nitrite may or may not be present
What does it mean nitrite is present in a urinalysis?
Enterobacterales are present
(convert nitrates to nitrites)
What can a urine culture tell us?
Helps identify organisms and confirm antibiotic susceptibility
What is the turnaround time for a urinalysis?
Hours
What is the turnaround time for a urine culture?
2-3 days
True or False: Repeat urine cultures after treatment are generally not recommended
True
What is the treatment for asymptomatic bacteriuria?
This does not require treatment!!!
Except a few special cases: pregnancy
*note that asymptomatic bacteriuria is extremely common in catheterized patients and antibiotic use is normally unnecessary
*What are the commonly used ORAL agents for UTI treatment?
Nitrofurantoin (uncomplicated)
Fosfomycin (uncomplicated)
Sulfamethoxazole/Trimethoprim
Fluoroquinolones (Ciprofloxacin, Levofloxacin)
Beta-Lactams
(Cephalexin, Cefadroxil, Cefpodoxime, Amox/Clav, Amoxicillin-not empiric)
What are the oral beta-lactam options for UTI treatment (outpatient)?
Cephalexin
Cefadroxil
Cefpodoxime
Amoxicillin/Clavulanate
Amoxicillin (not empiric)
What is the typical duration of complicated uti treatment?
7-14 days
What is the typical duration of uncomplicated uti treatment?
3-7 days
At what % resistance is an agent no longer recommended for empiric treatment?
20%
What are the commonly used empiric antibiotic therapy options for inpatient uti treatment?
Ampicillin + Gentamicin*
Cefazolin +/- Gentamicin
Ceftriaxone
Cefepime
Gentamicin
Which antibiotic does not cover enterococcus in uti’s?
any cephalosporins
*note that this is not the same as the nitrite producing enterobacterales
What UTI patients are at risk of developing bacteremia (bacteria in the bloodstream)?
Complicated UTI
Pyelonephritis
True or False: If a patient develops bacteremia, we need to use antibiotics for a longer duration of time
False
-use the same duration for complicated uti (7-14 days)
What additional considerations must we make when treating prostatitis?
Need to consider antibiotic penetration into the prostate
What are the treatment options for prostatitis?
Fluoroquinolones
Sulfamethoxazole/ Trimethoprim
Some Beta-Lactams (Cephalexin, Amox/Clav)
What is the duration of treatment for prostatitis?
2-4 weeks
(longer than any of the other urinary disease states)
What is the definition of recurrent UTI?
3 or more infections in one year
2 or more infections in 6 months
What are 3 potential causes of recurrent UTI’s?
Sexual intercourse and diaphragm/spermicide use
Postmenopausal women
Urologic abnormality
When may we consider uti prophylaxis?
If patient is experiencing recurrent uti’s
If no correctable cause is identified
*note that you want to choose the narrowest spectrum option when choosing prophylaxis
What are some options for uti prophylaxis?
Nitrofurantoin
Trimethoprim/Sulfamethoxazole
*avoid beta lactams
When determining susceptibility of oral agents based on results from IV agents, for Cephalexin and Cefpodoxime, what would the reference IV drug be?
Cefazolin
*Note that even though cefpodoxime is a 3rd gen cephalosporin, we would not use ceftriaxone
