Genitourinary Tract Infection Flashcards
For pyuria we consider:
10 leucocytes per microscopic field or 5–10 perhigh-powered field in centrifuged sample
For Bacteriuria we consider
10^5 colony-forming units per mL
and in two consecutive samples in women, or a single sample in men.
Criteria for cystitis or lower tract infection
dysuria, urinary frequency,
urinary urgency ± objective sign of suprapubic tenderness
Symptoms for acute Pyelonefritis
flank pain ± dysuria, urinary frequency and urgency
Symptoms for acute prostatitis
Subjective complaint of peroneal or suprapubic pain ± dysuria, urinary frequency and urgency
and can present with signs of sepsis including fever, usually significant prostatic tenderness on examination
Typically a complication of bacteremia;
also increasingly a recognized complication of ascending
infection including pyelonephritis.
Intrarenal abscess
Urinary pathogen by Hematogenous infection
Staphylococcus aureus
bacteremia and fungemia with Candida species.
Factors on E. coli cell surface include:
Adhesins and α-hemolysin toxin
Uropathogens that produce urease include
Proteus, Klebsiella, Pseudomonas spp.,
Staph aureus, Corynebacterium urealyticum
UTI in adults ——- impacts renal function
rarely
is associated with a 10% risk of subsequent development of UTI.
Catheterization
Risks in posmenopausal women
estrogen deficiency, incontinence, postvoid residual, catheterization.
Screening not recommended:
Premenopausal women, nonpregnant women.
* Diabetic women.
* Elderly subjects
* Spinal cord injury.
* Catheterized subjects
Flank pain that suggests a stone.
with radiation to the groin
Some quick tests for UTI can be:
Leucocyte esterase.
Nitrite
Nitrites aren´t useful for what type of bacteria
staphylococci or enterococci
Gram positives that can cause a UTI
Staphylococcus
Enterococcus
Corynebacterium urealyticum
Viral etiologies for UTI
Adenovirus AND BK virus
Relapse happens when:
1–2 weeks after stopping antibiotics
Lower tract should be treated with
nitrofurantoin or fosfomycin sufficient
Upper tract should be treated with
TMP–SMX), aminoglycosides.
Cystitis should be treated with
Nitrofurantoin 5 days, TMP–SMX 3 days, or
Fosfomycin 3 g × 1 dose.
Pyelonephritis should be treated with
Ciprofloxacin or 5 days with levofloxacin is adequate.
Some relapsing causes that should be considered are:
Deep-seated renal parenchymal infection.
Anatomical abnormality, e.g., stone.
Foreign body, e.g., stent.
In male, prostatic infection
Why does pregnant women have an increase of risk for UTI?
Increased estrogen causes muscle relaxation and reduced
tone leading to increased bladder capacity and impaired
bladder emptying as well as dilation of the ureters.
Despite the traditional UTI treatment, for pregnant women we should avoid:
FLQ, and Trimethoprim is usually avoided in the 1st trimester, TMP–SMX not recommended in the 3rd trimester
Severe multifocal infection with gas visible within the kidney and retroperitoneal space
Emphysematous Pyelonephritis
Emphysematous Pyelonephritis etiology
E. coli, Proteus, and Citrobac
Abscess that require percutaneous drainage.
> 5 cm
tenderness in the prostate is only present
in
Acute prostatitis
This is a diagnosis of exclusion with an absence of bacteriuria, but with significant perineal and pelvic pain impacting quality of life
Chronic Prostatitis/Chronic Pelvic Pain Syndrome
Bacterial causes for testicular inflammation
E. coli o Pseudomonas
Infectious disease with PAIN
Epididimitis
