General UT Infections - Unrein Flashcards
lower vs. upper UT infection
uretal opening of bladder
urinary tract infection
predominant female
- shorter urethra
- spermicides, pregnancy, vaginal atrophy
dysuria, frequency, urgency, strong urine odor, cloudy urine, suprapubic tender
urinary tract infection
simple cystitis
with or without dip stick in young female
tx on that basis without culture
culture indication -pregnant antibiotic resistant -drug sensitivity -underlying medical complication
complicated cystitis
any males - men rarely simple
require culture and structural evaluation
turbulent flow
where do you palpate the kidneys
sandwich method
pyelonephritis
appear toxic
-lloyds sign
elevated WBC with left shift
usually ascending bacteria
-also heme/lymph spread
asymptomatic bacteriuria
usually not treated
-treat if symptomatic or if pregnant
goal of treatment - prevent upper tract disease
urine is not sterile
female, diabetics, elderly
infection vs. colonization
if symptomatic
-dysuria, frequency, strong odor, etc.
urosepsis
SIRS
- may have hypothermia before hyperthermia
- WBC with left shift
- rigors
- 30% fatality
need blood and urine culture
pathogens in urine
gram negatives
gram positive
fungi - not routine cultures - candida
anaerobes - not on routine cultures
staph epidermidis
prosthetic device
enterococcus
group D strep
IV druguser
staph aureus
young women
staph saprophyticus
gram positives
strep and staph
stain darker purple
gram negative - pink
sterile pyuria
culture negative
mycobacterium tuberculosos adenovirus polyomavirus CMV anaerobes fungal interstitial cystitis
evaluation for UTI
CBC, renal chem urine dipstick urine culture imaging - US or CT urology/referral
positive dipstick for nitrites and leukocyte esterase
70-90% sensitive for UTI
negative - high negative predictive value
nitrites vs nitrates
nitrate - eukaryotes
nitrite - prokaryote (bacteria)
tx of UTI
nitrofurantoin - not good TMP/SMX FQs beta-lactams aminoglycosides
duration:
- simple cystitis 3 days
- complicated/pyelonephritis - 10-14 days
achilles tendon rupture
fluoroquinolone
side effect aminoglycosides
ototoxicity
nephrotoxicity
cranberry
to reacidify urine
UTI prevention
post-coital voiding
antibiotic prophylaxis - pregnant, diabetes, recurrent UTIs
topical estriol, cranberry, methenamine
methenamine
form formaldehyde in urine
fever and left flank pain
33yo M
sharing needles
elevated WBC count, aortic valve murmur, rash on palms
staph aureus
64yo M HIV positive, burning urination, dipstick leukocyte esterase, TNTC WBCs, no culture growth, most likely organism
candida
-immunocompromised
18yo F urinary burning and frequency, spermicide and condom us
simple cystitis
-no culture - treat empirically 3 days
