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PR3151 Finals > IC13 UTI > Flashcards

IC13 UTI Flashcards

1
Q

Differentiate asymptomatic bacteriuria (ASB) from urinary tract infection (UTI)

A

ASB- Isolation of significant colony counts of bacteria in the urine (bacteriuria) from a person WITHOUT symptoms of a UTI (asymptomatic)

UTI- Isolation of significant colony counts of bacteria in the urine from a person with urinary symptoms.

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2
Q

Who should be screened for ASB

A
  1. Pregnant women
  2. Patients going for urologic procedure in which mucosal trauma/bleeding is expected (TURP, cystoscopy
    with biopsy)
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3
Q

Reason to treat ASB in pregnancy

A

Prevent pyelonephritis, preterm labor, and infant low birth weight
- abx based on AST

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4
Q

Tx duration for ASB in pregnancy

A

4 to 7 days

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5
Q

Reason for treating pt going for urologic procedure in which trauma/bleeding is expected

A

prevent bactermia and urosepesis
-SAP (based on AST)

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6
Q

does mental status changes associate with UTI in absence of urinary sx

A

NO
deliurm + signs of systemic infection -> abx
deliurium + urinary sx -> abx

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7
Q

Routes of infection for UTI

A

Ascending and descending

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8
Q

Ascending route RF and microbes

A

RF: females (shorter urethra), use of spermicides, diaphragms as contraceptives
Organisms – E. coli, Klebsiella, Proteus

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9
Q

Hematogenous (descending) RF & microbes

A

Organism at distant primary site (eg heart valve, bone) -> bloodstream (bacteremia) -> urinary tract  UTI
organisms – Staphylococcus aureus,
Mycobacterium tuberculosis

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10
Q

Host Defense Mechanisms UTI

A
  • Bacteria in bladder stimulates micturition
  • Antibacterial properties
  • Anti-adherence mechanisms of bladder
  • Inflammatory response with polymorphonuclear
    leukocytes (PMNs phagocytosis)
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11
Q

Incr with obstruction/ urinary retention incr…

A

size of inoculum

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12
Q

Virulence/ pathogenicity example (UTI)

A

eg bacteria with pili (eg E. coli) resistant to washout or removal by anti-adherence mechanisms

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13
Q

Non pharm prevention of UTI

A
  • drink lots of fluids (6-8 glasses)
  • urinate frequently when feel the urge
  • urinate shortly after sex
  • wipe from front to back
  • wear cotton underwear/lose fitting -> keep area dry
  • avoid diaphragm or spermicide for birth control
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14
Q

complicated UTI definition

A

associated with conditions that increase the potential for serious outcomes, risk for therapy failure
* Eg UTIs in men, children and pregnant women
* Presence of complicating factors: functional and structural abnormalities of urinary tract, genitourinary instrumentation, diabetes mellitus, immunocompromised host

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15
Q

uncomplicated UTI

A

Usually in healthy premenopausal, non-pregnant women with no history suggestive of an abnormal urinary tract

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16
Q

RF for UTI

A
  • Females > males
  • Structural abnormalities eg prostatic hypertrophy, urethral strictures, tumours
  • Neurologic malfunctions eg stroke, diabetes, spinal cord injuries
  • Vesicoureteral reflux
  • Anti-cholinergic drugs (eg gen 1 anithistamines)
  • Catheterisation
  • Diabetes
  • Pregnancy
  • Sexual intercourse
  • Use of diaphragms & spermicides
  • Genetic association (positive family history)
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17
Q

Subjective sx of cystitis

A

dysuria, urgency, frequency, nocturia, suprapubic heaviness or pain; gross hematuria

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18
Q

subjective sx of pyelonephritis

A

fever, rigors, headache, nausea, vomiting, and malaise, flank pain, costovertebral tenderness (renal punch), or abdominal pain

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19
Q

how to collect urine

A

1) Midstream clean-catch
2) Catheterization
3) Suprapubic bladder aspiration

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20
Q

objective sx
WBC, RBC, microorganisms, WBC cast, epithelial cells

A

WBC >10 WBC/mm3 = pyuria
RBC > 5/HPF = hematuria
microorganisms (gram staining)
WBC cast positive = infection of kidneys (pyelonephritis)
epithelial cells positive = contamination

21
Q

T/F: absence of pyuria = unlikely UTI

A

WBC >10 WBC/mm3 = pyuria = UTI (TRUE)

22
Q

nitrate positive meaning

A

presence of Gram-negative bacteria

23
Q

leukocyte esterase postive test meaning

A

esterase activity of leukocytes in urine Correlates with significant pyuria (>10 WBCs/mm3)

24
Q

when to obtain/not obtain culture (UTI)

A

no: uncomplicated cystitis
may be necessary:
* Pregnant women
* Recurrent UTI (relapse within 2 weeks or frequent)
* Pyelonephritis
* Catheter-associated UTI
* All men with UTI

25
likely pathogens for uncomplicated/ community acquired UTI
1. E.coli 2. Staphylococcus saprophyticus 3. Enterococcus 4. Enterobacteriaceae (Klebsiella, Proteu, Enterobacter)
26
likely pathogens for complicated/ hospital acquired UTI
1. E.coli 2. Enterococci 3. Enterobacteriaceae (Klebsiella, Proteu, Enterobacter) 4. Pseudomonas aeruginosa (for HAI)
27
other possible organism (UTI)
S.aureus (from bacteremia, hematogenous route) Yeast/ candida - contamination
28
abx for cystitis in women
PO co trimoxazole 960mg BD x3d PO nitrofurantoin 50mg QID x5d PO fosfomycin 3g single dose (Beta lactams) x5-7d - PO amoxicillin-clavulanate 625mg BD - PO cephalexin 250-500mg QID - PO cefuroxime 250mg BD (Fluroquinolones) x3d - PO ciprofloxacin 250mg BD - PO levofloxacin 250mg OD
29
how long to treat for women with COMPLICATED cystitis
7-14days PO fosfomycin 3 g EOD x 3 doses
30
PO abx for CA pyelonephritis
PO fluoroquinolones * PO ciprofloxacin 500 mg twice OD x 7 days * PO levofloxacin 750 mg OD x 5 days PO co-trimoxazole 160/800 mg BD x 10-14d PO Beta-lactam x 10-14d * PO amoxicillin-clavulanate 625 mg tds * PO cephalexin 500 mg qid * PO cefuroxime 250-500 mg bid
31
IV abx for pyelonephritis in women
IV ciprofloxacin 400mg bid IV cefazolin 1g q8h IV amoxi-clav 1.2g q8h +/- IV/IM gentamicin 5mg/kg (cover ESBL)
32
abx for UTI in men
Cystitis only → follow women complicated (X7 -14d) (Cystitis + prostatitis + pyelonephritis) PO ciprofloxacin 500mg BD PO co trimoxazole 960mg BD - duration: 10-14d - confirmed prostatitis: 6 weeks
33
what other additional microbes to consider for noscocomial/ HAI UTI
P.aeruginosa ESBL
34
abx for noscocomial/ HAI UTI
IV cefepime ± IV amikacin 15mg/kg/d IV imipenem IV meropenem PO ciprofloxacin 500mg BD (for less sick pt) PO levofloxacin 750mg OD (for less sick pt) - duration 7-14d
35
defined CA-UTI
presence of symptoms or signs compatible with UTI with no other identified source of infection along with 10^3 cfu/mL of ≥1 bacterial species in a single catheter urine specimen within the previous 48h of catheter removal
36
RF for CA-UTI
* Duration of catheterisation * Colonisation of drainage bag, catheter and periurethral segment * DM * Female * Renal function impairment * Poor quality of catheter care, including insertion
37
microbes causing CA-UTI
short term (<7days) - single organism long term (>28days) - polymicrobial - same microbes as HA UTI
38
does CA-UTI cause symptoms? morbidity? mortality?
Symptomatic manifestation uncommon <10% febrile episodes Usually low-risk or not associated with excess mortality
39
tx decision for CA-UTI
- remove catheter - abx only for symptomatic infection (new onset or worsening of fever, rigors, altered mental status, malaise, or lethargy) - if stable, low grade fever -> consider observation - take urine/ blood culture
40
abx for CA-UTI
- IV imipenem 500mg q6H - IV meropenem 1g q8h - IV cefepime 2g q12H +/- IV amikacin 15mg/kg OD - PO/ IV levofloxacin 750mg x 5d (for mild CA-UTI) - PO Co-trimoxazole 960mg bid x 3d (for women ≤65 years with CA-UTI, no symptoms after an indwelling catheter has been removed) duration: 7d with prompt resolution, 10-14d if delayed response
41
is chronic suppressive tx recommended for CA-UTI
no
42
prevention of CA-UTI
* Avoid unnecessary catheter use * Use for minimal duration * Long-term indwelling catheters changed before blockage is likely to occur * Use of closed system * Ensure aseptic insertion technique * Topical, prophylactic, chronic suppressive antibiotics is not recommended
43
abx for pregnancy in UTI
avoid: ciprofloxain, cotrimoxazole (first and third trimester), nitrofurantoin (at term 38-42 weeks), AG beta-lactam are safe - tx duration: 4-7 days for ASB/ cystitis - 14 days for pyelonephritis fosfomycin can be used for the shortest period of time (cross placenta)
44
counselling for cephalexin
Take without regards to food, if GI discomfort, take with food.
45
advice for cotrimoxazole
N/V (take after food), photosensitivity, adequate hydration to prevent crystalluria, Discontinue at first sign of rash.
46
advice for ciprofloxacin/levofloxacin
GI upset (take w food). Administration apart from Ca, Fe. CNS (headache, dizziness), photosensitivity. Tendon inflammation (discontinue at first sign of pain, esp in elderly)
47
advice for nitrofurantoin
Take with food (incr absorption, reduce GI upset). Nausea, headache, dark coloured urine.
48
adjunctive tx UTI
NSAIDS - pain and fever Vomiting - rehydration Phenazopyridine 100-200mg TDS - urinary sx - avoid in G6PD deficiency - SE: N/V, orange urine and stool Urine alkalisation (need more evidence) cranberry juice intravaginal estrogen cream lactobacillus probiotics
49
goal and monitoring for UTI
1. resolution fo s/s - improve/ resolution 24-72 hrs - re-evaluate if fail to respond in 2-3d 2. bacteriological clearance 3. absence of ADR and allergies

PR3151 Finals (7 decks)

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