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Host and Defense > EXAM 3 UTIs > Flashcards

EXAM 3 UTIs Flashcards

1
Q

what is bacteriuria?

A
  • bacteria in urine
  • often colonization, not infection
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2
Q

what is a UTI?

A

bacterial infection of lower or upper urinary tract

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3
Q

what is acute cystitis?

A
  • bacterial infection of the bladder
  • infection (and symptoms) confied to lower urinary tract
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4
Q

what is acute pyelonephritis?

A

bacterial infection of upper urinary tract (ureters, renal pelvis, kidney parenchyma)

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5
Q

what are criteria of uncomplicated UTIs?

A
  • not pregnant
  • normal urinary anatomy
  • no co-morbitities (healthy, outpatient)
  • *patients with uncomplicated UTIs should meet ALL of these criteria
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6
Q

what are the criteria for complicated UTIs?

A
  • pregnant
  • abnormal urological anatomy or function
  • diabetes melitis
  • immune compromise
  • indwelling bladder catheter
  • male gender
  • *patients should be diagnosed with complicated UTI if they meet ANY of these criteria
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7
Q

by age ___, half of women have had at least one UTI

A

32

cystitis (lower UTI) is more common than pyelonephritis (upper UTI)

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8
Q

UTI develops in >___% of patients with indwelling urinary catheters

A

10

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9
Q

in healthy individuals in the absence of infection, which bacteria typically colonizes the lower urinary tract?

A. s. aureus

B. proteus species

C. eschericia coli

D. none of the above

A

D. none of the above

in young healthy individuals, the urinary tract should be sterile

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10
Q

T or F

the urinary tract is normally sterile in young, healthy patients

A

true

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11
Q

85% of bacteria that cause UTIs are ___ colonizers of the GI tract

A

gram negative

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12
Q

what are the main bacteria that cause UTIs that are gram negative colonizers of the GI tract

A
  • e. coli (predominant pathogen in UTIs: 75-95%)
  • proteus mirabilis
  • klebsiella pneumoniae
  • staphylococcus saprophyticus
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13
Q

describe the pathogenesis of UTIs

A
  • GI pathogens colonize peri-urethral mucosa
  • ascend through urethra to bladder
    • urethra is shorter in women than men
    • prostatic fluid has anti-bacterial properties
  • continue to ascend to ureters/kidney
    • less clear how this occurs
    • most untreated lower UTI will not progress to pyelonephritis
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14
Q

uropathogenic e. coli have multiple virulence factors. what are they?

A
  • pili
  • flagella
  • adhesins
  • siderophores
  • toxins
  • polysaccharide coating
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15
Q

the following symptoms are suggestive of what type of UTI?

pain or burning with urination (dysuria)

increased frequency of urination

increased urgency of urination

suprapubic pain

A

cystitis (lower UTI)

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16
Q

the following symptoms are suggestive of what type of UTI?

fever (>38.3*C)/ chills

flank or costo-vertebral angle pain

nausea/vomiting

A

pyelonephritis

can also have +/- symptoms of cystitis

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17
Q

what is the gold standard for diagnosis of UTIs?

A
  • symptoms + urine culture demonstrating >105 colony-forming units of uropathogenic bacteria per mL
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18
Q

a positive culture without symptoms = ___?

A

asymptomatic bactereuria

important distinction to make as this changes management (no antibiotics for asymptomatic bacteriuria)

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19
Q

describe a normal urinalysis

A
  • specific gravity = urine density/ density of water
  • nitrite negative = metabolic byproduct of some uropathogenic bacteria
  • RBCs and WBCs in urine should be less than 5 per high power field
  • some labs also report leukocyte esterase - a surrogate for presence of WBCs
20
Q

describe an abnormal urinalysis

A
  • cloudy urine with increased specific gravity
  • presence of nitrites suggest nitrogen-metabolizing organisms are present
  • hematuria and pyuria present
21
Q

what is the purpose of UA (urinalysis) / microscopy utility for UTI diagnosis?

A

to rule out UTI based on absence of pyuria (<10 WBC/hpf or negative leukocyte esterase)

22
Q

when is obtaining UA or microscopy not necessary for UTI diagnosis?

A

when specific UTI signs or symptoms are clearly present or absent

23
Q

___ alone is not an indication for antibiotics.

A

pyuria

it is not specific to UTI or sufficient to differentiate symptomatic UTI from asymptomatic bacteriuria

24
Q

pyuria is common in patients with ___

A

asymptomatic bacteriuria

25
Q

UTI symptoms are highly predictive of disease in what population?

A

young healthy patients

not every patient needs urine evaluation

26
Q

T or F:

lower bacterial colony counts are insignificant

A

false

they may be significant in a few instances

27
Q

diagnostic work up should depend on ___

A
  • illness severity and likelihood of other diagnoses
    • recurrent UTI (resistant organism?)
    • vaginal symptoms (is there a possibility of sexually transmitted infection?)
    • do not send urine cultures in patients without clinical symptoms
28
Q

can uncomplicated cystitis resolve itself without the use of antibiotics?

A
  • yes, it generally does
  • antibiotics are used to provide symptom relief
29
Q

what are 3 antibiotics that can be given for uncomplicated cystitis?

A
  • nitrofurantoin
  • trimethoprim-sulfa methoxazole (TMP/SMX)
  • fosfomycin
  • remember, these are used to provide symptom relief only and actually have minimum “ecologic effects”
30
Q

what are 3 drugs that can be given for uncomplicated pyelonephritis?

A
  • fluoroquinolones (ciprofloxacin or levofloxacin)
  • trimethoprim-sulfa methoxazole (TMP/SMX)
  • beta lactams (ceftriaxone, cefepime)
31
Q

if a patient with uncomplicated pyelonephritis is unstable (hemodynamic instability, cannot take PO, severe symptoms), what should be done?

A

they should be admitted to the hospital for IV antibiotics

32
Q

e. coli resistance to ___ is not >20% worldwide

A

amoxicillin

33
Q

___ resistance is 20% and rising quickly

A

fluoroquinolone

34
Q

___ antibiotics will have major ecologic effect by killing normal GI flora (collateral damage)

A

broad spectrum

this has lead to a trend toward prescribing narrower spectrum antibiotics

35
Q

is there a need for antibiotics in asymptomatic bacteriuria?

A
  • no, unless:
    • patient is pregnant
    • pre-urology procedure
    • renal transplant
    • neutropenic
  • antibiotics do not decrease asymptomatic bacteriuria or prevent subsequent development of UTI
36
Q

what is the prevalence of asymptomatic bacteriuria in healthy pre-menopausal women?

A

1-5%

37
Q

what is the prevalence of asymptomatic bacteriuria in post-menopausal women?

A

2.8-8.6%

38
Q

what is the prevalence of asymptomatic bacteriuria in diabetic women?

A

9-27%

39
Q

what is the prevalence of asymptomatic bacteriuria in female long term care residents?

A

25-50%

40
Q

what is the prevalence of asymptomatic bacteriuria in male long term care residents?

A

15-40%

41
Q

describe the cost of unnecessary Rx and missed diagnosis

A
  • drug-drug interactions
  • renal and other complications
  • drug allergies
  • c. difficile infection
  • missing the real diagnosis
  • no improvement in UTIs
  • increased risk of developing resistant organisms in your patient
42
Q

a patient is admitted with an indwelling bladder catheter. urine culture reveals >105 Cfu e. coli. there are no urinary symptoms and the patient feels well. what is the best management?

A. remove catheter if possible, no other treatment

B. initial broad spectrum antibiotic

C. change the catheter and re-culture

D. start a low-dose long-term antibiotic while catheter is in place

A

A. remove catheter if possible, no other treatment

43
Q

what are the symptoms of catether-associated UTIs?

A
  • usually lack typical UTI symptoms
  • new fever with no other source
  • CVA tenderness, flank pain, pelvic discomfort
44
Q

describe the diagnosis of catheter-associated UTI

A
  • presence of inflammation on urinalysis (pyuria) doesn’t correlate with infection
  • absence of pyuria rules out CA-UTI
  • urine culture with >/= 105 cfu bacteria
  • UA/culture must be interpreted based on clinical scenario
45
Q

what is the treatment for CA-UTI?

A
  • remove catheter whenever possible
  • replace catheters that have been in >/= 2 weeks if still indicated
  • antibiotic duration
    • 7 days if prompt response
    • 3 days if catheter removed in female patient with no evidence of associated pyelonephritis
46
Q

what is the relationship of bacteriuria to asymptomatic bacteriuria and catheter-associated UTI?

A
  • bacteriuria
    • patient without urinary catheter
      • ASB or UTI
    • patient with urinary catheter
      • ASB or CA-UTI
  • bacteriuria means a positive urine culture

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