Exam 3 - Interstitial Cystitis Flashcards
What can cause false negative nitrite urine dipstick results?
- Non-nitrate reducing organisms
- Frequent urination/urine in bladder < 4 hours (not enough time to be reduced)
What can cause false positive leukocyte esterase urine dipstick results?
- Vaginal contamination
- Trichomonas infection
What is the term for an upper urinary tract infection?
Pyelonephritis
What terms are used for a lower urinary tract infection?
- Cystitis
- Prostatitis
- Urethritis
The urinary tract is normally sterile and resistant to bacterial colonization, so what do they occur from?
Ascending bacterial infections
What bacteria accounts for most UTI cases?
E. coli
Describe an acute simple cystitis.
Confined to the bladder with no signs or symptoms suggestive of an upper urinary tract or systemic infection
Describe an acute complicated UTI.
Acute UTI with signs/symptoms that suggest extension beyond the bladder such as fever, chills, flank pain, CVA tenderness, pelvic pain.
What special populations are more at risk of developing a complicated UTI?
- Pregnant women
- Men
- Those with comorbidities, immunocompromised, or have underlying urologic abnormalities
What are common symptoms associated with ac acute simple cystitis?
- Dysuria, urinary frequency, urgency
- +/- hematuria
- +/- suprapubic discomfort
Based on the following UA results, what do you suspect?
- (+) Leukocyte esterase
- (+) Nitrites
- (+) Pyuria (> 10 leukocytes)
- Bacteriuria
- No WBC or RBC casts
Acute simple cystitis
When is a urine culture recommended?
- Atypical presentation
- Suspect complicated UTI
- Symptoms do not resolve or recur
- Suspect antimicrobial resistance
- Special populations
What represents a positive culture in women with typical symptoms of cystitis?
> 10^2 CFU/mL
What can be used for symptomatic treatment in acute simple cystitis?
OTC Phenazopyridine (Pyridium) 200 mg TID prn for 2 days
What are the primary antibiotic therapies for acute simple cystitis in a non-pregnant woman?
- Nitrofurantoin (Macrobid)
- Bactrim
- Fosfomycin
***Avoid Nitrofurantoin and Fosfomycin if early pyelonephritis due to low renal concentrations/unlikely to be effective
What are alternative antibiotic therapies for acute simple cystitis in a non-pregnant woman?
- Beta-lactams (Augmentin, Cefdinir)
- Fluoroquinolones (Cipro, Levaquin)
What are the antibiotics options for acute simple cystitis in a pregnant woman?
Which antibiotic should be avoided?
- Augmentin, Cefpodoxime, Fosfomycin
- Nitrofurantoin or Bactrim - use/avoid based on trimester (consult/refer to OB)
Avoid Fluoroquinolones
What are the primary antibiotic therapies for acute simple cystitis in men?
- Nitrofurantoin (Macrobid)
- Bactrim
- Fosfomycin
***Same choices as a non-pregnant female, but must be given for longer duration of 7 days
What are the primary antibiotic therapies for acute simple cystitis in patients with comorbidities, immunocompromised, or underlying urologic abnormalities?
- Nitrofurantoin (Macrobid)
- Bactrim
- Fosfomycin
***Same choices as a non-pregnant female and men, but must be given for longer duration of 1-2 weeks
Are follow-up urine cultures needed in patients with acute simple cystitis whose symptoms resolve on antibiotics?
No, except for pregnant women
What are typical signs/symptoms in a patient with acute pyelonephritis/complicated UTI?
- Dysuria, urinary frequency, urgency (lower urinary tract symptoms)
- Flank pain
- Fever, chills
- GI symptoms
- CVA tenderness
Based on the following UA results, what do you suspect?
- (+) Leukocyte esterase
- (+) Nitrites
- (+) Pyuria (> 10 leukocytes)
- Bacteriuria
- WBC casts present
Acute pyelonephritis
What is the imaging test of choice if needed in acute pyelonephritis?
CT A/P (with and without contrast)
What is the outpatient management for mild-moderate acute pyelonephritis?
- Fluoroquinolones (Cipro or Levaquin x 5-7 days)
- Bactrim x 7-10 days if pathogen is known to be susceptible
- Initial IV/IM dose of Ceftriaxone followed by either Cipro or Levaquin if known to be FLQ resistant
- Pyridium x 2 days for dysuria
