GU infections Flashcards
Types of GU tract infections
- acute cystitis
- acute pyelonephritis
- acute bacterial prostatitis
- infectious stone disease
- epididymitis
- fournier’s gangrene
What is acute cystitis? (causes)
inflammation of the bladder due to:
- bacterial infections (most common)
- stones
- interstitial cystitis
- radiation (prostate and colon cancer)
- bladder cancer
What is the most common infection in women?
- bacterial cystitis
- occurs in 25-30% of women b/t 30-40 you
- 1/3 women have an infection before the age of 24
- it is uncommon for men until around the age of 50 when the prostate enlarges and can cause bladder outlet obstruction
What is the most common cause of nosocomial acute cystitis?
- catheter associated infections
- bacterial colonization with catheterization occur at a rate of 5%/ day and reaches 100% in 30 days
RFs for acute cystitis
- incomplete bladder emptying due to: BPH, diabetics, neuologic (pinched nerve), MS
- sexual intercourse
- benign prostatic enlargment
- stones
Pathogenesis of acute cystitis
- female urethra is short, making it easy for bacteria to enter the bladder in retrograde fashion
- E. coli (most commonly found in the bowel) is the most common bacteria accounting for 85 of CA-infections and 50% of nosocomial infections
What other organisms other than E. coli cause acute cystitis?
- proteus, klebsiella, pseudomonas, Enterococcus faecalis, and Staph saprophyticus
- Proteus, klebsiella pneumonia, staph saprophyticus, increases the urine pH and can lead to stone formation.
- see proteus: think stone
Clinical presentation of acute cystitis?
irritative voiding symptoms:
- frequency, urgency, dysuria, hematuria (culture to make sure infection), suprapubic discomfort
work up of acute cystitis?
- physical exam: pts may have suprapubic tenderness otherwise exam is usually normal
- lab work: UA, urine culture
Tx of acute cystitis
1-3 days of single dose abx therapy (if complicated: 5-10)
abx therapy: 1s line
- nitrofurantoin
- Trimethoprim-sulfamethoxazole (if allergic to sulfas -> just do trimethoprim)
- cephalosporins
- fluoroquinolones should be used for comp. infections due to increasing resistant E. coli strains
What is acute pyelonephritis and the causative agents?
it is an infection of the upper urinary tract including the renal pelvis and renal parenchyma
- gram - most common: E. coli proteus klebsiella enterobacter pseudomonas
RFs of acute pyelonephritis
- obstruction of the urinary tract
- stones
- UPJ obstruction, vessel crossing over
- vesicoureteral reflux: urine shoot back up when urinating
- diabetes mellitus
- female gender
Pathogenesis of acute pyelonephrititis
- pathogenesis: bacteria ascend from the lower urinary tract into collecting ducts
- hematogenous route: staph aureus or candida in the bloodstream
- lymphatic: very unusual, gains access into kidney from an intraperitoneal abscess
Clinical presentation of acute pyelonephritis
- fever
- chills
- flank pain
- malaise
- N/V
- irritative voiding symptoms
PE: CVA tenderness
lab work up of acute pyelonephritis
CBC: leukocytosis
UA: hematuria, bacteriuria, pyuria
urine culture: positive
blood cultures: may also be positive -> pretty sick
Imaging for acute pyelonephritis
renal ultrasound
abdominal and pelvic CT scan w/ and w/o contrast
Tx of acute pyelonephritis
10-14 days parenteral or oral abx: start with IV until afebrile, then switch over to oral - IV ampicillin or gentamicin - IV cefazolin - IM ceftriaxone (rocephin) Trimethoprim-sulfamethoxazole or fluoro
What causes acute bacterial prostatitis?
infection and inflammation of the prostate by:
- E. coli
- klebsiella
- enterobacter
- staph aureus
accounts for 1/4 of males office visits for GU tract sxs
RFs of acute bacterial prostatitis
- BPH
- urethral stricture disease (straining)
- urethral catheterization
- neurogenic bladder
- calculi
- diabetes
Pathogenesis of acute bacterial prostatitis
bacteria ascend up the urethra into the bladder and infected urine reflux into the prostatic ducts
Clinical presentation of acute bacterial prostatitis
- present with vague pelvic and systemic sxs
- irritative voiding sxs
- dysuria
- perineal and low back pain
- difficulty voiding or retention
PE: prostate may be enlarged, tender or boggy
- avoid prostate massage
Lab work on acute bacterial prostatitis
CBC: leukocytosis
UA: positive leukocytes, blood, and nitrites
- urine culture is +
Tx of acute bacterial prostatitis
- acutely ill pts require hospitalization
- management with broad-spectrum abx ( ampicillin and gentamicin) until culture is back
- switch to oral abx after pt is afebrile for 24-48 hours
- 4- 6 weeks: trimethoprim-sulfamethoxazole or fluoroquinolone
- for urinary retention a percutaneous suprapubic tube should be placed
Chronic bacterial prostatitis
can be a sequela of acute bacterial prostatitis, bacterial ascend up the urethra and into the prostate like ABP
- gram - rods: most common
- e. coli 80% of cases, klebsiella, pseuodomonas aeruginosa, and proteus less common
- pts presents same as ABP -> suprapubic pain
- some patients require a prostate massage
- meares-stamey four glass test
1: test 2: midstream 3: massage prostate and test again 4: rest of the urine
Tx of chronic bacterial prostatitis
- 4-8 weeks of abx
- anti-inflammatories
- hot sitz baths
- alpha blocker
What is infectious stone disease and struvite stones?
struvite stones: composed of combo of magnesium ammonium phosphate and carbonate apatite
- more common in females
- formed from urease producing organisms that split urea into ammonia
What are the possible causative agents of struvite stones?
- proteus mirabilis most common
- H. flu
- staph aureus
- klebsiella
Where do the struvite stones end up?
known to encompass the entire collecting duct of the kidney, known as stag horn calculus
- they are radiodense, CT scans, renal ultra sounds, KUB will detect stone ( KUB won’t detect uric acid stones)
Tx of struvite stones?
tx: fluoroquinolones, percutaneous nephrolithotomy (break up the stone -> get cultured, figure out what is causative agent. Stone needs to come out
what is epididymitis? causative agents?
- most common cause of scrotal pain in adults in outpt setting
- most commonly caused by infection
- can be acute or chronic
- chlamydia trachomatis and neisseria gonorrhoeae most common organisms in men under age of 35
- older men: suspect E. coli or pseudomonas
presentation of acute epididymitis?
- severe swelling, and exquisite pain of surrounding structures
- fevers
- irritative voiding sxs
- clinical features: palpation reveals induration and swelling of involved epididymis with pain
- some develop a hydrocele if infection to testicle
Dx and Tx of acute epididymitis?
dx: made clinically and may be confirmed with urine studies
- scrotal US
Tx: ceftriaxone 250 mg IM one dose + doxy 100 mg bid x 10 days
- alt to doxy: azithro
- if suspect abscess refer to urology
chronic epididymitis presentation and findings
- scrotal or testicular swelling
- discomfort
- usually lack irritative voiding symptoms
- think about other abnormalitis of GU tract: kidney stone?
clinical features: subtle induration or tenderness, w/ or w/o swelling
- may feel inflammatory nodule with nontender epididymis
- UA usually negative
TX: conservative
What is Fournier’s gangrene? clinical features?
- necrotizing fasciitis of the perineum caused by mixed infection of aerobic/anaerobic bacteria
clinical features: tense edema of scrotal wall blisters/ bullae subcutaneous gas fever tachycardia/ hypotension Dx: CT and MRI
( this is seen in uncontrolled diabetics that are obese -> not painful so it goes unnoticed)
Pathogens of mourner’s gangrene?
GABS
anaerobic species: bacteroides and clostridium
Enterobacteriaceae:
E. coli, enterobacter, klebsiella, proteus
Tx of fournier’s gangrene?
surgical
empiric: carbapenem or beta lactam + Beta lactamase inhibitor PLUS clindamycin PLUS agent against MRSA (vanco)
Causes of acute cystitis?
- incomplete bladder emptying and sexual intercourse
- more common in females
- E. coli usual pathogen
- just use fluoroquinolones for complicated infections
Acute pyelonephritis summary?
gram - rod most common (E. coli)
- flank pain, fever and chills at presentation
- need to rule out obstruction
Acute bacterial prostatitis summary?
E. coli most common pathogen
- very tender prostate, prostate massage CI
- may have to be hospitalized
- tx includes IV and oral abx
Chronic bacterial prostatitis summary
- gram - rods most common
- physical exam can be normal
- prostate massage useful for dx: meares - stamey four glass urine test
- tx 4-6 weeks with TMP-SMX or fluoroquinolones
- saw palmetto: herbal supplement for good prostate health and decreases inflammation
Struvite stones summary
most common in females
- composed of magnesium ammonium phosphate and carbonate apatite
- proteus most common pathogen
- can form in weeks or months -> usually form into stag horn calculi
- pts usually need percutaneous nephrolithotomy for removal
summary of epididymitis
swollen testicle, in young adults: think STI, tx with doxy plus cephalosporin (gonorrhea)
Summary of fourneir’s gangrene
- seen in obese uncontrolled diabetics
- need imaging to evaluate extent
- mixed aerobes/anaerobes or group A strep
tx: surgery and combo abx: carbapenems, or B-lactam+ lactamase inhibitors + vanco + clindamycin
