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Repro II Exam II > Genitourinary infections Lecture (Unrein) > Flashcards

Genitourinary infections Lecture (Unrein) Flashcards

1
Q

when is culture indicated regardless of presentation with simple cystitis

A

pregnancy

antibiotic resistance

pt’s has multiple drug sensitivities

underlying complicating medical conditions

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2
Q

what are the conditions that not only require a culture but a structural evaluation

A

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

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3
Q

presentation of pyelonephritis

A

fever, toxic appearing, Lloyd’s sign

elevated white blood cells count with a left shift

usually from ascending bacteria OR hematogenous spread

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4
Q

what constitutes an infection

A

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.

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5
Q

asymptomatic bacteriuria is more commonly found in

A

female
diabetics
elderly (nursing home pt’s)

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6
Q

when do you treat asymptomatic bacteriuria ?

A

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 !!

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7
Q

urosepsis presentation

A

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

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8
Q

what tests/studies are necessary and part of the evaluation of urosepsis

A

imaging!

obstructive uropathy or suspected structural integrity alteration (foreign bodies, tumors, etc.)

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9
Q

staph saprophyticus is seen in what pt’s

A

seen almost exclusively in young women

seen in summer - grows better in warm weather

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10
Q

staph epidermidis

A

prosthetic devices

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11
Q

staph aureus

A

injection drug users

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12
Q

what constitutes sterile pyuria and what organisms are included in this ?

A

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

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13
Q

what labs are performed for GU problems

A

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

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14
Q

Positive for nitrites and leukocyte esterase

A

is 68-88% sensitive for a urinary tract infection

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15
Q

Negative for nitrites and leukocyte esterase on urine dipstick

A

has a high negative predictive value

almost certain they don’t have urinary tract infection

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16
Q

how do you treat GU infections

A

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

17
Q

Fluoroquinolone side effect

A

achilles tendon rupture

18
Q

what are the common complications aminoglycosides

A

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)

19
Q

simple cystitis duration of treatment

A

usually 3 days

20
Q

complicated cystitis/pyelonephritis duration of treatment

A

10-14 days (possibly 7-10 days if worried about antibiotic overuse)

21
Q

how do women prevent GU infections

A

post-coital voiding

cranberry juice

22
Q

what are some non-antibiotic prophylaxis for preventing GU complications

A

topical estriol replacement (vaginally)

cranberry juice

methenamine - metabolized by prokaryotic cells in fermaldehyde

23
Q

in what patients do you use antibiotic prophylaxis

A

pregnancy - prevent low birth weights

diabetes - only in certain circumstance s

recurrent UTI’s- not for asymptomatic bacteremia

24
Q

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
A

C) Staphylococcus aureus

he is abusing IV drugs
and has heart murmurs

could be staph epidermitis too

25
Q

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
A

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

26
Q

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

A) Simple cystitis – no workup and treat empirically for three days

Repro II Exam II (8 decks)

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