Genitourinary infections Lecture (Unrein) Flashcards
when is culture indicated regardless of presentation with simple cystitis
pregnancy
antibiotic resistance
pt’s has multiple drug sensitivities
underlying complicating medical conditions
what are the conditions that not only require a culture but a structural evaluation
complicated cystitis:
Recurrent in Female Males - men rarely present with simple cystitis Urethral malformations Turbulent urine flow (strictures and obstruction) Neurogenic Bladder Nephrolithasis Immunocompromised Renal disease Pregnancy Diabetes Catheterization
- Urethral
- Suprapubic
- Nephrostomy
Upper tract disease
presentation of pyelonephritis
fever, toxic appearing, Lloyd’s sign
elevated white blood cells count with a left shift
usually from ascending bacteria OR hematogenous spread
what constitutes an infection
Dysuria, frequency, urgency, strong urine odor, cloudy urine, suprapubic tenderness on physical examination
– a host response is an indication of an infection versus a colonization.
asymptomatic bacteriuria is more commonly found in
female
diabetics
elderly (nursing home pt’s)
when do you treat asymptomatic bacteriuria ?
pregnant women bc associated with premature birth and low birth weight. no vertical transmission of illness
urinary outflow obstruction
anticipated urinary instrumentation
diabetics (controversial)
usually you don’t treat it !!
urosepsis presentation
Septic (Systemic Inflammatory Response System)
- tachycardiac, tachypneic, fever or low temperature, leukocytosis.
patients may actually have a hypothermic body temperature as the initial symptom
Usually an elevated WBC with a left shift
Rigors
what tests/studies are necessary and part of the evaluation of urosepsis
imaging!
obstructive uropathy or suspected structural integrity alteration (foreign bodies, tumors, etc.)
staph saprophyticus is seen in what pt’s
seen almost exclusively in young women
seen in summer - grows better in warm weather
staph epidermidis
prosthetic devices
staph aureus
injection drug users
what constitutes sterile pyuria and what organisms are included in this ?
when you culture on a plate it won’t grow!!
includes:
mycobacterium tuberculosis
adenovirus
polyomavirus
cytomegalovirus
anaerobes
fungal
interstitial cysitis - poorly understood entitiy, check these pt’s in every way and can’t figure out what is going on but still have these GU symptoms. not easily treated
what labs are performed for GU problems
CBC
renal function
urine dip stick
-nitrites and leukocyte esterase
urine culture
- colony counts- how severe the infection is
- antibiotic sensitivity patterns
Imaging
- U/S
- CT scan
Urology referral/cystoscopy
Positive for nitrites and leukocyte esterase
is 68-88% sensitive for a urinary tract infection
Negative for nitrites and leukocyte esterase on urine dipstick
has a high negative predictive value
almost certain they don’t have urinary tract infection
how do you treat GU infections
Nitrofurantoin- bacteriostatic – can cause interstital pulmonary fibrosis
TMP/SMX- bactericidal *** GOOD
Fluoroquinolone - bactericidal
Beta-Lactam antibiotics - bactericidal
-don’t work if the bug has a cell wall
Aminoglycosides
-variably bacteriostatic vs. bactericidal
Fluoroquinolone side effect
achilles tendon rupture
what are the common complications aminoglycosides
ototoxicity and nephrotoxicity
fluid in the cochlea is derived from cellular machinery very similar to whats in the proximal convoluted tubules (pee in your head)
simple cystitis duration of treatment
usually 3 days
complicated cystitis/pyelonephritis duration of treatment
10-14 days (possibly 7-10 days if worried about antibiotic overuse)
how do women prevent GU infections
post-coital voiding
cranberry juice
what are some non-antibiotic prophylaxis for preventing GU complications
topical estriol replacement (vaginally)
cranberry juice
methenamine - metabolized by prokaryotic cells in fermaldehyde
in what patients do you use antibiotic prophylaxis
pregnancy - prevent low birth weights
diabetes - only in certain circumstance s
recurrent UTI’s- not for asymptomatic bacteremia
A 33 y/o male intravenous drug user presents with a fever and left flank pain. He admits to sharing needles. He often trades sex for injection drugs. He has an elevated WBC count, a new loud aortic valve murmur, splinter hemorrhages and a rash on his palms. He is HIV negative. He relates that his father had a heart murmur. He has no genital abnormalities and no recent history of genital lesions. You suspect the most likely etiology of his pyelonephritis to be:
A) Secondary syphilis B) Staphylococcus saprophyticus C) Staphylococcus aureus D) Candida species E) Bacteroides species
C) Staphylococcus aureus
he is abusing IV drugs
and has heart murmurs
could be staph epidermitis too
A 64 y/o male who is positive for HIV and on broad spectrum beta-lactam antibiotics for pneumonia complains of burning with urination, urinary frequency and urinary urgency. His urine stream is otherwise normal. A urine dip-stick is strongly positive for leukocyte esterase and the lab reports that he has too numerous to count white blood cells per high powered field on the microscopic examination of the urine. After three days the lab reports there is no growth on the cultures. What is the most likely causative organism of his urinary tract infection?
A) Staphylococcus saprophyticus B) Bacteroides species C) Esherichia coli D) Candida species E) Enterococcus species
candida species
he is immunocompromised (HIV) and fungal infections DO NOT grow on culture (sterile pyuria)
wiped out normal flora b/c he is on antibiotics
An 18 y/o female college student reports to you a sudden onset of urinary burning and frequency 2 days after becoming sexually active for the first time. She informs you that her partner used a condom, a spermicide and had no penile discharge, lesions or symptoms. You diagnosis and approach to this case is:
A) Simple cystitis – no workup and treat empirically for three days
B) Complicated cystitis – culture and antibiotic sensitivities and treat on those results
C) Simple cystitis – urine dipstick to confirm and treat for ten days
D) Complicated Cystitis – Culture and imaging and treat only after that work up and based on culture results
E) Work up and evaluation for STDs as these are the cause of her symptoms
A) Simple cystitis – no workup and treat empirically for three days
