Genitourinary Tract Infections Flashcards
Genitourinary Tract Infections types?
7
Acute Cystitis Acute Pyelonephritis Acute Bacterial Prostatitis Chronic Bacterial Prostatitis Infectious Stone Disease Epididymitis Fournier’s Gangrene
Cystitis refers to inflammation of the urinary bladder due to what?
5
Bacterial Infections (most common) Stones Interstitial Cystitis Radiation Bladder cancer
What is the most common GU infection in women?
Bacterial Cystitis
It is uncommon for men until around the age of 50. Why is it common then?
when the prostate enlarges and can cause bladder outlet obstruction.
What are the most common nosocomial infection?
Catheter-associated infections
Risk factors for Acute cystitis?
4
- Incomplete bladder emptying
- Sexual intercourse
- Benign Prostatic enlargement
- Stones
What conditions would cause incomplete bladder emptying?
4
- BPH
- Diabetes
- Neurologic
- Multiple Sclerosis
What is the most common bacteria accounting for 85% of community-acquired infections and 50% of nosocomial infections?
Escherichia coli (most commonly found in bowel)
What other organisms are common in UTI?
5
- Proteus,
- Klebsiella,
- Pseudomonas,
- Enterococcus faecalis, and 5. Staphylococcus saprophyticus
Which bacteria increase the urine pH and can lead to stone formation?
3
Proteus,
Klebsiella pneumoniae, and Staph. Saprophyticus
Acute cystitis Clinical Presentation?
5
Irritative voiding symptoms
- Frequency
- Urgency
- Dysuria
- Hematuria
- Suprapubic discomfort
Dont ever treat someone who has a chronic indwelling catheter. Why?
Just creating resistance
What would be a finding on a physical exam for acute cystitis?
Patient’s may have suprapubic tenderness other wise the exam is usually normal
What lab work would we do for acute cystitis?
2
UA
Urine culture
How would we treat acute cystitis?
which drugs are first line and how often?
3 drugs
1-3 days of single dose antibiotic therapy
Antibiotic therapy First-line drugs include: 1. Nitrofurantoin (first) 2. Trimethoprim-sulfamethoxazole 3. Cephalosporins
When should we use floroquinolones for acute cystitis?
Fluoroquinolones should be used for complicated infections due to increasing resistant E-coli strains
What is Acute Pyelonephritis?
Pyelonephritis is an infection of the upper urinary tract including the renal pelvis and renal parenchyma
What are the most common bacteria?
(Acute Pyelonephritis)
In general?
Specific bacteria? 5
Gram-negative bacteria are the most common
E-coli Proteus Klebsiella Enterobacter Pseudomonas
Risk factors for Acute Pyelonephritis?
4
- Obstruction of the urinary tract
- Vesicoureteral reflux
- Diabetes mellitus
- Female gender
What are some examples of obstructions of the urinary tract?
2
Stones
UPJ obstruction
Pathogenesis
of Acute Pyelonephritis?
Bacteria ascend from the lower urinary tract into collecting ducts
Acute Pyelonephritis can also infect through the Hematogenous route. What bacteria usually infect this way?
2
Staphylococcus aureus or Candida in the bloodstream
Acute Pyelonephritis can also enter through the lymphatics. How does this happen?
Lymphatic
Very unusual
Gains access into kidney from an intraperitoneal abscess
Acute Pyelonephritis
clinical presentation?
6
Fever Chills Flank pain Malaise Nausea and vomiting Irritative voiding symptoms
Finding on physical exam for Acute Pyelonephritis?
Costovertebral angle tenderness (CVA) may be prominent finding
Lab work for acute pyelonephritis?4
Lab work
1. CBC
- UA
- Urine culture positive
- Blood cultures may also be positive
What would a CBC show for posiitve acute pyelonephritis?
What would a UA show for posiitve acute pyelonephritis?3
Leukocytosis
Hematuria
Bacteriuria
Pyuria
Imaging for acute pyelonephritis?2
Renal Ultrasound
Abdominal and pelvic CT scan with and without contrast
Treatment of acute pyelonephritis?
4 options
How long?
Treatment Management is usually 10-14 days Parenteral or oral antibiotics 1. IV ampicillin or gentamicin 2. IV cefazolin 3. IM ceftriaxone (Rocephin) 4. Trimethoprim-sulfamethoxazole or fluoroquinolone
Acute Bacterial Prostatitis
is what and what bacteria usually cause it?
5
Infection and inflammation of the prostate by: 1. E-coli 2 Klebsiella 3. Proteus mirabilis 4. Enterobacter 5. Staphylococcus aureus
Acute Bacterial Prostatitis
Risk Factors?
6
BPH Urethral stricture disease Urethral catheterization Neurogenic bladder Calculi Diabetes
Acute Bacterial Prostatitis pathogenesis?
Bacteria ascend up the urethra into the bladder and infected urine reflux into the prostatic ducts
Acute Bacterial Prostatitis
Clinical Presentation
5
Present with vague pelvic and systemic symptoms Irritative voiding symptoms Dysuria Perineal and low back pain Difficulty voiding or retention
Acute Bacterial Prostatitis findings on physical exam?
2
Prostate may be enlarged, tender, or boggy
Avoid prostate massage
Acute Bacterial Prostatitis
Lab work
3
CBC
UA
Urine culture is positive
What will the CBC show for Acute Bacterial Prostatitis?
What about the UA?3
Leukocytosis
Positive leukocytes, blood, and nitrites
Acute Bacterial Prostatitis
Treatment
What should we treat with until the culture is back?
2
after patient is afebrile for 24-48 hours what should we do?
What should we treat for 4-6 weeks (oral antibiotics)?
2
Acutely ill patients require hospitalization
Management with broad-spectrum antibiotics (ampicillin and gentamicin) until culture is back
Switch to oral antibiotics
Trimethoprim-sulfamethoxazole or fluoroquinolone
For urinary retention with Acute Bacterial Prostatitis
what should we do?
a percutaneous suprapubic tube should be placed
Can be a sequela of acute bacterial prostatitis (ABP)?
Chronic Bacterial Prostatitis
Pathology is the same
What is the most common bacteria types for Chronic Bacterial Prostatitis?
General?
Most common and three others?
Gram-negative rods most common
- E-coli 80% of cases
Klebsiella, Pseudomonas aeruginosa, and Proteus are less common
Whats the difference bewteen CBP and ABP?
Patients presents the same as ABP but less sick
Some patients require prostate massage
(first cup pee then massage prostate vigorously then pee again)
Whats the Meares-Stamey four glass test?
first cup pee
then midstream
then massage prostate vigorously then pee again)
then pee the rest
Chronic Bacterial Prostatitis
Treatment consist of what?
4
4-8 weeks of antibiotic
Anti-inflammatories
Hot sitz baths
Alpha-blocker
Struvite stones
Composed of what?
2
More common in females or males?
combination of magnesium ammonium phosphate and carbonate apatite
females
How are the stones formed?
What bacteria is the most common?
What are three other less common bugs it could be?
Formed from urease producing organisms that split urea into ammonia
Proteus mirabilis is most common
Other pathogens include:
Haemophilus influenzae
Staph aureus
Klebsiella
What is staghorn calculus?
What imaging can detect stones?
3
How should we treat it?
2
Struvite stone are known to encompass the entire collecting system of the kidney
CT scans, Renal Ultrasound, and KUB can detect the stone
Treatment
- Fluoroquinolone
- Percutaneous Nephrolithotomy
Most common cause of scrotal pain in adults in the outpatient setting is what?
What is it most commonluy caused by?
Epididymitis
Most commonly caused by infection
Acute or Chronic
Whats the most common bugs associated with Epididymitis in men under 35?2
Older men what bugs are more common?2
Chlamydia trachomatis and Neisseria gonorrhoeae most common organisms in men under age 35
Older men suspect Escherichia coli or Pseudomonas species
What symptoms would present with acute epididymitis?
3
What would palpation in a epididymis pt reveal?
If infection moves to the testicle what can develop?
- Severe swelling and exquisite pain of surrounding structures
- Fevers
- Irritative voiding symptoms
reveals induration and swelling of involved epididymis with pain
hydrocele
How would you diagnose acute Epididymitis?
2
- Made clinically and may be confirmed with urine studies
2. Scrotal US
How would we treat acute epididymitis?
2
Alternative?
Ceftriaxone 250mg IM one dose plus Doxycycline 100mg bid x 10 days
Z pack
Symptoms of chronic epidiymitis?
3
- Scrotal or testicular swelling
- Discomfort
- Usually lack irritative voiding symptoms
Clinical findings of chronic epididymitis?
3
- Subtle induration or tenderness, with or without swelling
- May feel inflammatory nodule with nontender epididymis
- UA usually negative
How do we treat chronic epididymitis?
conservatively
What is Fournier’s Gangrene?
Clinical features?5
How do we diagnose it? 2
Necrotizing fasciitis of the perineum caused by mixed infection of aerobic/anaerobic bacteria
- Tense edema of the scrotal wall
- Blisters/bullae
- Subcutaneous gas
- Fever
- Tachycardia/hypotension
CT and MRI
Anaerobic species that are involved in Fournier’s Gangrene?2
Other pathogen that is aerobic and involved with it?
Bacteroides
Clostridium
Group A Streptococcus (hemolytic streptococcal gangrene)
Enterobacteriaceae involved with Fournier’s Gangrene?
4
E. coli
Enterobacter
Klebsiella
Proteus
Treatment of Fournier’s Gangrene?
2
Surgical
Empiric (antibiotics)
What antibiotic would you use for Fournier’s Gangrene?
4
- Carbapenem or beta-lactam-beta-lactamase inhibitor,
plus
Clindamycin,
plus
Agent against MRSA
Vancomycin
If culture is negative for acute cystitis what do we need to rule out?
2
cancer
stones
What do we need to rule out for Acute Pyelonephritis?
obstruction
Who is Fournier’s Gangrene
most common in?
Obese uncontrolled diabetics
What is prostate massage contraindicated in?
Acute Bacterial Prostatitis
Very tender prostate
Chronic will not have tender prostate
and massage indicated
