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PR3151 > IC13 UTI > Flashcards

IC13 UTI Flashcards

1
Q

Define asymptomatic bacteriuria and UTI

A

Asymptomatic bacteriuria contains bacteria in urine but no infection is present.

UTI contains bacteria in urine and infection is present.

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2
Q

Name 3 groups of population in which asymptomatic bacteriuria is commonly found in.

A
  1. Elderly in long term care facility
  2. People with spinal cord injury
  3. People with indwelling catheter use
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3
Q

Which group of population should screening for asymptomatic bacteriuria be done in?

A
  1. Pregnant women (during 12 to 16 weeks gestation)
  2. Patients undergoing urologic procedure in which mucosal trauma/ bleeding is expected. (before procedure)
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4
Q

Why is screening for asymptomatic bacteriuria done for pregnant women?

A

Prevent pyelonephritis, pre-term labor and infant low birth weight

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5
Q

Pregnant women with confirmed asymptomatic bacteriuria diagnosis should be treated with active antibiotics for _____ to _____ days.

A

4, 7

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6
Q

Why is screening for asymptomatic bacteriuria done for PT undergoing urologic procedure in which mucosal trauma/ bleeding is expected ?

A

Prevent bacteremia and urosepsis.

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7
Q

PT undergoing urologic procedure in which mucosal trauma/ bleeding is expected with confirmed asymptomatic bacteriuria diagnosis should be given antibiotics as _____.

A

surgical antibiotics prophylaxis

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8
Q

Should urinary catheter placement be given to PT undergoing urologic procedure in which mucosal trauma/ bleeding is expected?

A

No (prevent biofilm formation)

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9
Q

Name an example of upper UTI.

A

Pyelonephritis

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10
Q

Name four examples of lower UTI.

A
  1. cystitis (bladder)
  2. urethritis (urethra)
  3. prostatitis (prostate)
  4. epididymitis (epididymis)
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11
Q

What is considered complicated UTI?

A

UTI that increases potential for serious outcomes and risk for therapy failure

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12
Q

Who often present with complicated UTI?

A

Males, children, pregnant women with complicating factors, abnormalities of urinary tract, genitourinary instrumentation, DM, immunocompromised

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13
Q

Who often present with uncomplicated UTI?

A

Healthy premenopausal, Non-pregnant women, no history of abnormal urinary tract

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14
Q

Prevalence of UTI _____ with age.

A

Increases

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15
Q

UTI is more common in _______ than _______ in infants aged 0 to 6 months.

A

Males, females

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16
Q

UTI is more common in ______ than _______ aged 1 to adult stage.

A

females (shorter urethra), males

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17
Q

Prevalence of UTI is the same in those aged ______ due to diseases causing ___________ and ________ of urine.

A

65 and above
obstruction
retention

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18
Q

What is the pathogenesis of ascending UTI?

A

Colonic or fecal flora colonies paraurethral area/ urethra and move up to bladder and kidney.

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19
Q

Who is at risk of ascending UTI?

A

Females in general due to shorter urethra and those who use spermicides, diaphragms as contraceptive.

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20
Q

What are the common bacteria found in ascending UTI?

A

Enterobacterial Gut Gram Negative (E.coli, Kleb, Proteus)

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21
Q

What is the pathogenesis for hematogenous (descending) UTI.

A

Organism at distant primary site such as those in bacteremia (from blood stream) move to urinary tract.

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22
Q

What are the common bacteria found in descending UTI?

A

(Non gut bacteria) S.aureus, Mycobacterium tuberculosis

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23
Q

What are the three determining factors for UTI? Briefly mention the rationale.

A
  1. Impaired host defense mechanisms (antibacterial properties of urine and prostate secretion, increase diuresis in presence of bacteria, anti-adherence mechanism, anti-inflammatory response with polymorphonuclear leukocytes)
  2. Size of inoculum (increase with obstruction or urinary rentention)
  3. Virulence or pathogenicity of bacteria (e.g. E.coli with pili are resistant to washout)
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24
Q

How can UTI be prevented. Name at least 3 examples.

A
  1. Increase fluid intake
  2. Urinate frequently/ after sexual intercourse
  3. Women should wipe from front to back after urination
  4. Wear cotton underwear and loose fitting area to keep area dry
  5. Women should consider other birth control methods since unlubricated condoms increase bacteria growth
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25
Q

What are some subjective symptoms of lower UTI (cystitis)?

A
  1. dysuria
  2. urgency
  3. frequency
  4. nocturia
  5. suprapubic heaviness/ pain
  6. gross hematuria (blood in urine)
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26
Q

What are some subjective symptoms of pyelonephritis?

A
  1. fever
  2. rigors
  3. headache
  4. N/V
  5. malaise
  6. flank pain
  7. costovertebral tenderness (renal punch - suggestive of swollen kidney)
  8. abdominal pain
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27
Q

What are some signs and symptoms that needs to be looked out for in elderly?

A

Drowsy, less alert, GI issues, change in eating habits

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28
Q

What are some tests that can be conducted for UTI patients?

A
  1. Microscopic (WBC and WBC cast, RBC, gram stain)
  2. Chemical urinalysis (dipstick)
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29
Q

WBC of > _________ WBC/mm3 suggest pyuria and is indicative of UTI

A

10

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30
Q

RBC of > ______/ high powerfield or gross suggest hematuria.

A

5

31
Q

Nitrite of minimally _____ bacterial/ml in urine may suggest UTI

A

10^5

32
Q

Presence of nitrite in urine indicate presence of gram ___ bacteria.

A

negative

33
Q

What are the factors that may result in false positive of nitrite urinary test?

A

Gram positive bacteria
P.Aeruginosa
Low urine pH
Frequent voiding
Diluted urine

34
Q

_______ leukocyte esterase correlates with significant pyuria.

A

Positive

35
Q

Should urine cultures be done for uncomplicated cystitis?

A

No

36
Q

What bacteria can cause uncomplicated or community acquired UTI?

A

E.coli (gram negative - 85%)
S.saprophyticus (gram positive - 5 to 15%)

37
Q

What bacteria can cause complicated or healthcare associated UTI?

A

E.coli (gram negative - 50%)
Enterococci (gram positive)

38
Q

What are the adjunctive therapy that can be given to patients with UTI?

A

Paracetamol/ NSAIDs (pain and fever)

Rehydration (vomiting)

Phenazopyridine (urinary symptoms)

39
Q

How does phenazopyridine work?

A

It is an azo dye that exerts topical analgesic effect on urinary tract mucosa to provide symptomatic relief.

40
Q

How is phenazopyridine given?

A

100 to 200mg TDS

41
Q

Phenazopyridine is contraindicated in ______.

A

G6PD

42
Q

What are some adverse effects of phenzopyridine?

A

N/V, orange red discoloration of urine and stool

43
Q

What are the 1st line antibiotics options available for treatment of uncomplicated cystitis in women? Provide the dose and duration where applicable

A
  1. PO Cotrimoxazole 800/160mg BID for 3 days
  2. PO Nitrofurantoin 50mg QID for 5 days
  3. PO fosfomycin 3g single dose
44
Q

What are the alternative antibiotics options available for treatment of uncomplicated cystitis in women? Provide the dose and duration where applicable

A

PO beta-lactams for 5 to 7 days (PO cefuroxime 250mg BID, PO Amoxicillin-clavulanate 625mg, PO cephalexin 250 to 500 QID)

Fluoroquinolones for 3 days (PO ciprofloxacin 250mg BID, PO levofloxacin 250mg daily)

45
Q

Which of the antibiotics in treatment of UTI concentrates well in urine?

A

Cotrimoxazole and fluoroquinolones

46
Q

What is the duration of treatment for complicated cystitis in women?

A

7 to 14 days

47
Q

What is the dose of fosfomycin for complicated cystitis?

A

PO 3g EOD x 3 doses

48
Q

Is nitrofurantoin and fosfomycin used for pyelonephritis?

A

No (does not concentrate well in kidneys)

49
Q

What are the 1st line antibiotics options available for treatment of community acquired pyelonephritis? Provide the dose and duration where applicable

A

PO fluoroquinolones (PO ciprofloxacin 500mg BD 7 days, PO levofloxacin 750mg OD 5 days)

PO co-trimoxazole 800/160mg BD 10 to 14 days

PO beta-lactam 10 to 14 days (PO cefuroxime 250 - 500mg BID, PO Amoxicillin-clavulanate 625mg TDS, PO cephalexin 500 QID)

50
Q

What are the alternative antibiotics options available for treatment of community acquired pyelonephritis in severely ill patients? Provide the dose and duration where applicable

A

IV ciprofloxacin 400mg BID
IV cefazolin 1g q8H
IV Amoxicillin-clavulanate 1.2g q8H AND/OR IV/IM gentamicin 5mg/kg

51
Q

What are the 1st line antibiotics options available for treatment of community acquired UTI in men with no concerns for prostatitis? Provide the dose and duration where applicable

A
  1. PO Cotrimoxazole 800/160mg BID
  2. PO Nitrofurantoin 50mg QID
  3. PO fosfomycin 3g EOD x 3 doses
52
Q

What are the alternative antibiotics options available for treatment of community acquired UTI in men with no concerns for prostatitis? Provide the dose and duration where applicable

A

PO beta-lactams for 5 to 7 days (PO cefuroxime 250mg BID, PO Amoxicillin-clavulanate 625mg, PO cephalexin 250 to 500 QID)

Fluoroquinolones for 3 days (PO ciprofloxacin 250mg BID, PO levofloxacin 250mg daily)

53
Q

What are the antibiotics options available for treatment of community acquired UTI in men with no concerns for prostatitis? Provide the dose and duration where applicable

A

PO ciprofloxacin 500mg BID
PO co-trimoxazole 800/160 BID

54
Q

What is the duration of treatment if there is no concern for prostatitis in men with community acquired UTI?

A

7 to 14 days

55
Q

What is the duration of treatment if there is concern for prostatitis or pyelonephritis in men with community acquired UTI?

A

10 to 14 days. Extend to 6 weeks if pyelonephritis

56
Q

Is culture need for men with UTI?

A

Yes

57
Q

What is nosocomial UTI?

A

UTI that occurs after >48 hours post hospital admission

58
Q

What is healthcare-associated UTI?

A

UTI that occurs when one had been hospitalized previously or underwent invasive urological procedure in the last 6 months.

59
Q

What other bacteria should be covered in nosocomial or HA-UTI?

A

P.aeruginosa and ESBL bacteria

60
Q

What is the duration of treatment of nosocomial or HA-UTI?

A

7 to 14 days

61
Q

What are the antibiotics options available for treatment of nosocomial or HA-UTI? Provide the dose and duration where applicable

A
  1. IV cefepime 2g q12H +/- IV amikacin 15mg/kg/d
  2. IV imipenem 500mg q6H
  3. IV meropenem 1g q8H
  4. PO levofloxacin 750mg BID
  5. PO ciprofloxacin 500 BID
62
Q

What are the antibiotics options available for treatment of catheter associated UTI? Provide the dose and duration where applicable

A
  1. IV impenem 500mg Q6H or IV meropenem 1g Q8H
  2. IV cefepime 2g Q12H +/- IV amikacin 15mg/kg (1 dose or daily)
  3. PO/IV levofloxacin 750 x 5 days
  4. PO-cotrimoxazole 960mg BID x 3d (for women ≤ 65yo without upper UTI symptoms after removal of indwelling catheter)
63
Q

What are the risk factors for catheter associated UTI?

A
  1. Duration of catheterization
  2. Colonization of drainage bag, catheter and periureteral segment DM
  3. DM
  4. female
  5. renal impaired
  6. Poor quality of catheter care, including insertion
64
Q

Polymicrobial organisms are found if catheter is place for _____________ and more than ______ days.

A

long term
28

65
Q

What is the definition of catheter associated UTI?

A

UTI symptoms and signs without other source of infection and 10^3 cfu/mL of ≥ 1 bacterial species in a single catheter. Should have indwelling catheter or if removed within 48 hours

66
Q

Should culture be taken for catheter associated UTI?

A

Yes, before giving antibiotics

67
Q

How can catheter associated UTI be prevented?

A
  1. Avoid unnecessary catheter use
  2. Use for minimal duration
  3. Long term indwelling catheter
  4. Use of closed system
  5. Ensure aseptic insertion technique
  6. Avoid topical and prophylactic antiseptic or antibiotics
  7. Avoid chronic suppressive therapy
68
Q

How is UTI treated during pregnancy?

A
  1. beta lactam
  2. fosfomycin
69
Q

What is the duration of treatment during pregnancy?

A

4 to 7 days for asymptomatic bacteriuria or cystitis

14 days for pyelonephritis

70
Q

What antibiotics are contraindicated for pregnancy?

A
  1. Ciprofloxacin (fetal cartilage damage, arthropathies)
  2. Co-trimoxazole (first tri - folate anatgonism leading to neural tube defects; third tri - kernicterus; G6PD deficient)
  3. Nitrofuratoin (at term - 38 to 42 weeks due to concerns for G6PD in children)
    4, Aminoglycoside (8th cranial nerve toxicity)
71
Q

Resolutin of symptoms take place after ______ to ______hours.

A

24, 72

72
Q

Culture for pregnant women is needed for ________ of clearance.

A

documented

73
Q

Is repeat culture needed for patients who responded?

A

No

PR3151 (2 decks)

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