Infections Flashcards
1
Q
Urinary Tract Infection (UTI)
Risk factors
A
- Female gender
- Pregnancy
- Sexual intercourse “honeymoon cystitis”
- Indwelling catheters
- DM
- Impaired bladder emptying
- Stones
- Structural abnormalities (men with UTIs have it more than women)
- Tumor or prostate hypertrophy
- Recent antibiotic use
- Immunosuppression
2
Q
Cystitis
Presentation
A
- Dysuria
- Suprapubic pain or discomfort
- Frequency and urgency
- Mild or no fever
3
Q
Cystitis
Common Bugs
A
- E. coli (the most common of all)
- S. saprophyticus in sexually active young women (E. coli is still more common in this group)
- Klebsiella
- P. mirabilis
- Pseudomonas
- Serratia
- Enterobacter
4
Q
Cystitis
Diagnosis
A
- Clinical bases
- Urine analysis (more than 5-10 WBCs/hpf)
- Urine culture (> 10^5 CFU/mL)
- Positive leukocyte esterase (a marker of WBCs)
- Positive nitrites test indicates gram -ve organisms especially E. coli
- Sterile pyuria and -ve urine cultures suggest urethritis by N. gonorrhoeae or C. trachomatis
5
Q
Uncomplicated UTI (cystitis) (Treatment)
A
- Nitrofurantoin or fosfomycin for 3-5 days
- TMP/SMZ if local resistance is low
- Ciprofloxacin (reserved from routine use to avoid resistance)
- Cefixime
6
Q
Complicated UTI (cystitis) (Definition)
A
- Urinary obstruction
- Men
- Renal transplant
- Catheters
- Instrumentations
7
Q
Complicated UTI (cystitis) (Treatment)
A
Treat with the following for 7-14 days:
- Nitrofurantoin or fosfomycin
- TMP/SMZ if local resistance is low
- Ciprofloxacin (reserved from routine use to avoid resistance)
- Cefixime
8
Q
UTI in Pregnancy
Treatment
A
- Treat asymptomatic bacteruria or symptomatic UTI with nitrofurantoin or amoxicillin for 3-7 days
- Confirm clearance with post-treatment urine culture
9
Q
Acute Pyelonephritis
Presentation
A
- Sudden onset flank with costovertebral angle tenderness
- High fever
10
Q
Acute Pyelonephritis
Diagnosis
A
- Urine analysis shows WBC casts and microscopic hematuria
- Urine culture (bugs as that of cystitis)
- Send for blood cultures to rule out urosepsis
- CBC reveals leukocytosis
- U/S or CT scan only indicated in patients who relapse or do not respond to therapy within 48-72 hrs
11
Q
Acute Pyelonephritis
Complications
A
- Chronic pyelonephritis
- Renal papillary necrosis
- Perinephric abscess
- Urosepsis
12
Q
Acute Pyelonephritis
Treatment
A
- Mild case can be treated on an outpatient bases for 7-14 days with Fluoroquinolones (first line therapy) and increase fluid intake with close monitoring
- In patients with serious medical complications, systemic symptoms, pregnancy, present with severe nausea and vomiting, or have suspected bacteremia; admission with IV antibiotics:
- Ceftriaxone (first line)
- Ertapenem
- Ampicillin and gentamicin until culture results are known
- Fluoroquinolones
13
Q
Acute Pyelonephritis
Pathology
A
- Neutrophils infiltrate renal interstitium
- Affects cortex with relative sparing of glomeruli/vessels
14
Q
Chronic Pyelonephritis
Pathology
A
- Macro.: coarse, asymmetric corticomedullary scarring and blunted calyx
- Micro.: tubules contain eosinophilic casts resembling thyroid tissue (thyroidization of the kidney)
15
Q
Xanthogranulomatous Pyelonephritis
Pathology
A
Granulomas with lipid-laden macrophages (foamy cells)
