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Infectious Disease > GU infections > Flashcards

GU infections Flashcards

1
Q

Types of GU tract infections

A
  • acute cystitis
  • acute pyelonephritis
  • acute bacterial prostatitis
  • infectious stone disease
  • epididymitis
  • fournier’s gangrene
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2
Q

What is acute cystitis? (causes)

A

inflammation of the bladder due to:

  • bacterial infections (most common)
  • stones
  • interstitial cystitis
  • radiation (prostate and colon cancer)
  • bladder cancer
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3
Q

What is the most common infection in women?

A
  • 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
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4
Q

What is the most common cause of nosocomial acute cystitis?

A
  • catheter associated infections

- bacterial colonization with catheterization occur at a rate of 5%/ day and reaches 100% in 30 days

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5
Q

RFs for acute cystitis

A
  • incomplete bladder emptying due to: BPH, diabetics, neuologic (pinched nerve), MS
  • sexual intercourse
  • benign prostatic enlargment
  • stones
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6
Q

Pathogenesis of acute cystitis

A
  • 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
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7
Q

What other organisms other than E. coli cause acute cystitis?

A
  • 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
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8
Q

Clinical presentation of acute cystitis?

A

irritative voiding symptoms:

- frequency, urgency, dysuria, hematuria (culture to make sure infection), suprapubic discomfort

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9
Q

work up of acute cystitis?

A
  • physical exam: pts may have suprapubic tenderness otherwise exam is usually normal
  • lab work: UA, urine culture
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10
Q

Tx of acute cystitis

A

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
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11
Q

What is acute pyelonephritis and the causative agents?

A

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
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12
Q

RFs of acute pyelonephritis

A
  • obstruction of the urinary tract
  • stones
  • UPJ obstruction, vessel crossing over
  • vesicoureteral reflux: urine shoot back up when urinating
  • diabetes mellitus
  • female gender
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13
Q

Pathogenesis of acute pyelonephrititis

A
  • 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
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14
Q

Clinical presentation of acute pyelonephritis

A
  • fever
  • chills
  • flank pain
  • malaise
  • N/V
  • irritative voiding symptoms

PE: CVA tenderness

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15
Q

lab work up of acute pyelonephritis

A

CBC: leukocytosis
UA: hematuria, bacteriuria, pyuria

urine culture: positive
blood cultures: may also be positive -> pretty sick

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16
Q

Imaging for acute pyelonephritis

A

renal ultrasound

abdominal and pelvic CT scan w/ and w/o contrast

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17
Q

Tx of acute pyelonephritis

A 
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
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18
Q

What causes acute bacterial prostatitis?

A

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

19
Q

RFs of acute bacterial prostatitis

A
  • BPH
  • urethral stricture disease (straining)
  • urethral catheterization
  • neurogenic bladder
  • calculi
  • diabetes
20
Q

Pathogenesis of acute bacterial prostatitis

A

bacteria ascend up the urethra into the bladder and infected urine reflux into the prostatic ducts

21
Q

Clinical presentation of acute bacterial prostatitis

A
  • 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

22
Q

Lab work on acute bacterial prostatitis

A

CBC: leukocytosis
UA: positive leukocytes, blood, and nitrites
- urine culture is +

23
Q

Tx of acute bacterial prostatitis

A
  • 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
24
Q

Chronic bacterial prostatitis

A

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
25
Q

Tx of chronic bacterial prostatitis

A
  • 4-8 weeks of abx
  • anti-inflammatories
  • hot sitz baths
  • alpha blocker
26
Q

What is infectious stone disease and struvite stones?

A

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
27
Q

What are the possible causative agents of struvite stones?

A
  • proteus mirabilis most common
  • H. flu
  • staph aureus
  • klebsiella
28
Q

Where do the struvite stones end up?

A

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)

29
Q

Tx of struvite stones?

A

tx: fluoroquinolones, percutaneous nephrolithotomy (break up the stone -> get cultured, figure out what is causative agent. Stone needs to come out

30
Q

what is epididymitis? causative agents?

A
  • 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
31
Q

presentation of acute epididymitis?

A
  • 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
32
Q

Dx and Tx of acute epididymitis?

A

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
33
Q

chronic epididymitis presentation and findings

A
  • 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

34
Q

What is Fournier’s gangrene? clinical features?

A
  • 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)

35
Q

Pathogens of mourner’s gangrene?

A

GABS
anaerobic species: bacteroides and clostridium
Enterobacteriaceae:
E. coli, enterobacter, klebsiella, proteus

36
Q

Tx of fournier’s gangrene?

A

surgical

empiric: carbapenem or beta lactam + Beta lactamase inhibitor PLUS clindamycin PLUS agent against MRSA (vanco)

37
Q

Causes of acute cystitis?

A
  • incomplete bladder emptying and sexual intercourse
  • more common in females
  • E. coli usual pathogen
  • just use fluoroquinolones for complicated infections
38
Q

Acute pyelonephritis summary?

A

gram - rod most common (E. coli)

  • flank pain, fever and chills at presentation
  • need to rule out obstruction
39
Q

Acute bacterial prostatitis summary?

A

E. coli most common pathogen

  • very tender prostate, prostate massage CI
  • may have to be hospitalized
  • tx includes IV and oral abx
40
Q

Chronic bacterial prostatitis summary

A
  • 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
41
Q

Struvite stones summary

A

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
42
Q

summary of epididymitis

A

swollen testicle, in young adults: think STI, tx with doxy plus cephalosporin (gonorrhea)

43
Q

Summary of fourneir’s gangrene

A
  • 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

Infectious Disease (27 decks)

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