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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
Q

likely pathogens for uncomplicated/ community acquired UTI

A
  1. E.coli
  2. Staphylococcus saprophyticus
  3. Enterococcus
  4. Enterobacteriaceae (Klebsiella, Proteu, Enterobacter)
26
Q

likely pathogens for complicated/ hospital acquired UTI

A
  1. E.coli
  2. Enterococci
  3. Enterobacteriaceae (Klebsiella, Proteu, Enterobacter)
  4. Pseudomonas aeruginosa (for HAI)
27
Q

other possible organism (UTI)

A

S.aureus (from bacteremia, hematogenous route)
Yeast/ candida - contamination

28
Q

abx for cystitis in women

A

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
Q

how long to treat for women with COMPLICATED cystitis

A

7-14days
PO fosfomycin 3 g EOD x 3 doses

30
Q

PO abx for CA pyelonephritis

A

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
Q

IV abx for pyelonephritis in women

A

IV ciprofloxacin 400mg bid
IV cefazolin 1g q8h
IV amoxi-clav 1.2g q8h

+/- IV/IM gentamicin 5mg/kg (cover ESBL)

32
Q

abx for UTI in men

A

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
Q

what other additional microbes to consider for noscocomial/ HAI UTI

A

P.aeruginosa
ESBL

34
Q

abx for noscocomial/ HAI UTI

A

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
Q

defined CA-UTI

A

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
Q

RF for CA-UTI

A
  • Duration of catheterisation
  • Colonisation of drainage bag, catheter and periurethral segment
  • DM
  • Female
  • Renal function impairment
  • Poor quality of catheter care, including insertion
37
Q

microbes causing CA-UTI

A

short term (<7days) - single organism
long term (>28days) - polymicrobial
- same microbes as HA UTI

38
Q

does CA-UTI cause symptoms? morbidity? mortality?

A

Symptomatic manifestation uncommon
<10% febrile episodes
Usually low-risk or not associated with excess mortality

39
Q

tx decision for CA-UTI

A
  • 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
Q

abx for CA-UTI

A
  • 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
Q

is chronic suppressive tx recommended for CA-UTI

A

no

42
Q

prevention of CA-UTI

A
  • 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
Q

abx for pregnancy in UTI

A

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
Q

counselling for cephalexin

A

Take without regards to food, if GI discomfort, take with food.

45
Q

advice for cotrimoxazole

A

N/V (take after food), photosensitivity, adequate hydration to prevent crystalluria,
Discontinue at first sign of rash.

46
Q

advice for ciprofloxacin/levofloxacin

A

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
Q

advice for nitrofurantoin

A

Take with food (incr absorption, reduce GI
upset). Nausea, headache, dark coloured urine.

48
Q

adjunctive tx UTI

A

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
Q

goal and monitoring for UTI

A
  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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