Exam 4 - UTI Flashcards
1 bacteria of UTI?
E Coli
Risk factors in UTI?
Spermicide, new sex partner <12mo, sex >3x/week, hx UTI, maternal UTI
2 definitions of recurrent UTI?
2+ in 6 months, or
3+ in 12 months
Sx of UTI?
Dysuria, frequency & urgency, hesitancy, hematuria, suprapubic pain
Dx UTI with no labs?
Yes, if PT has new dysuria, frequency, and hematuria. No vag discharge and no complicating factors.
What does Urine Dipstick check?
- Leukocyte esterase
- Nitrites (enterobacc bacteria)
What is Pyuria? Which test can detect it?
WBCs in urine. Urine Microscopy.
Urine Microscopy tests for?
Pyuria (WBCs in urine), hematuria, WBC casts
What do positive WBC casts on urine microscopy signify?
Kidney inflammation
What two tests combine to Urinalysis?
Dipstick + Microscopy
What is gold standard for testing urine? When not to use?
Urine Culture. Don’t use in uncomplicated UTI.
Is there a single best tx for uncomplicated UTI? Goal of tx?
No single best test!
Goal=less collateral dmg, less ecological effect
Tx options for uncomplicated UTI?
- Bactrim DS x3 days (not if resist >20% or had in 3-6 mo)
- Nitro (Macrobid) x5 days (caution if CrCl <30)
- Fosfomycin x1 day
Alt: Cipro, B-Lactam
Definition of complicated cystitis?
Preggers, urologic abnormal, immunocompromised, men, DM (?), preadolescent, post-menopausal.
Tx of UTI if preggers?
Macrobid (nitrofurintonin). NOT Bactrim!
Recurrent UTI prophylaxis options?
Bactrim SS 40/200
Nitro 50-100
Dx for Complicated Cystitis
Urine Culture TOC. Follow up with another culture 1 week after tx.
When to follow-up with urine culture?
1 week after tx
Which drug to avoid in pregnant UTI?
Bactrim. Use Macrobid (Nitrofurintonin).
When to screen pregnant women for UTI?
In 1st trimester and periodically after
Who to screen for UTI?
Pregger women, urologic surgery PT
Who to treat if ASx UTI positive?
Pregnant women, urologic surgery PT, renal transplant, neutropenic PT
Tx for Recurrent UTI?
Nutrofurintonin or Bactrim
If treat PT with recurrent UTI and they have another < 6 months what to do?
Use different agent than before
When to prophylaxis for recurrent UTI?
After 2nd in 6 months or 3rd in 12 months with culture on record.
2 major S/Sx in Acute Pyelonephritis?
- Fever >38C/100.4F
2. CVA tenderness
Dx for Acute Pyelonephritis
Urine Culture!!!
When to order imaging for Acute Pyelonephritis?
- If severe or worsening after appropriate abx in for 48-72h
- ≥2 episodes
- Persistent hematuria, stone, abscess, or obstruction
First-line emperic tx for Acute Pyelonephritis? What caution?
Fluoroqinolones IV or PO 5-7 days. Caution with >10% resistance.
Other abx tx or Acute Pyelonephritis
- Bactrim DS BID x14 days
- PO Beta-lactam
When to admit Acute Pyelonephritis PT?
Hemodynamically unstable, DM, renal stones, preggers, PO meds not tolerated d/t severe nausea & vomiting
Urine culture shows entercoccus in the urine, even if the person is asymptomatic and non-pregnant, treat?
Yes!!!
Treatment options for Urine culture shows entercoccus in the urine, even if the person is asymptomatic and non-pregnant?
Nitrofurantonin. Amoxicillin/Ampicillin if Nitrofuratoin is not available.
Tx for Complicated UTI?
- Fluoroquinolones
2. Aminoglycosides
Tx for Recurrent UTI and Uncomplicated UTI?
- Fosfo 3g x1
- Nitro 100mg BID x5 days
- Bactrim DS x3 days
What are the two most accurate indicators of Uncomplicated UTI?
Nitrites and Leukocytes on dipstick
When to treat women with catheter-acquired bacteruria after removal?
At least 48 hours
When to treat PT with chronic indwelling catheter?
When symptomatic
Should screen older ASx PTs for UTI?
No. Only if symptomatic.
How to screen pregger women for UTI? When?
Urine cultures at end of first trimester.
“Leukocyte esterase and nitrite tests have low sensitivity for identifying bacteriuria in women who are pregnant, these patients should be screened with urine cultures.”
Routine screening of ASx women w/DM?
Not supported
ABX for ASx UTI preggers?
Amoxicillin, (Augmentin), Ampicillin, Cefuroxime (Ceftin), Cephalexin (Keflex), Nitrofurantoin (Furadantin)
