Infections Of Adult Urinary Tract Flashcards by Max Kaczmarek

What should you consider in any children w/ a UTI prior to toilet training?

Vesicoureteral reflux

VCUG and refer

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If a child has a fever what should be on your differential?

UTI

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What are natural (intrinsic defense mechanisms against a UTI)?

efficient bladder emptying
protective glycosaminoglycan layer
urine: high osmolarity, extremes of pH

Women: normal vagina flora

Males: prostatic fluid (zinc)

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Female UTI risk factor?

Short urethra

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Male uti risk factor?

Increased incidence if uncircumcised and insertive anal intercourse

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What are general UTI risk factors?

Retentiion (obstruction, BPH, stones, pregnancy) , stasis, reflux

Diabetes
Foreign bodies

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What is the MC route of UTI?

Ascending infection from the urethra

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What is the MC route for pyelonephritis?

Ascent of infection up the ureter

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Acute UTIs are caused by how many pathogens?

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Chronic UTIs are caused by how many pathogens?

2 or more pathogens

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What is the MC cause of an uncomplicated UTI?

Ecoli (ascending poop)

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What is the MC cause of nosocomial or hospital acquired UTIs?

Pseudomonas and staphylococcus

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What is the treatment for asymptomatic bacteriuria?

No treatment UNLESS

Pregnancy
Invasive urologic procedure (catheter, imaging)

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What is acute cystitis?

Bladder infection from coliform bacteria and gram positive bacteria

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What is cystitis common presentation?

Irritating voiding (frequency, urgency, dysuria)

Gross hematuria

Symptoms following intercourse

Suprapubic tenderness

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What patient would you consider imaging for in cystitis?

Male patients

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What would your labs look like for cystitis?

UA: Pyuria, bacteriuria, hematuria

Urine culture

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Who is an uncomplicated UTI?

Acute cystitis in an otherwise health NONPREGNANT adult woman

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What is the drug of choice for acute cystitis?

Trimethoprim-sulfamethoxazole 160/800 mg BID x 3ds

What is the drug of choice of pregnant women w/ acute cystitis?

Nitrofurantoin 100 mg BID x 7 days

What acute cystitis treatment discolors the urine?

Phenazopyiridine (pyridium)

What should you consider in a male w/ acute cystitis?

Anatomic defect, infected stones, prostatitis, chronic urinary retention, uncircumcised men (SEXUAL HX)

Who is eligible for acute cystitis prevention?

Women w/ >3 episodes/yr that have been referred to ortho and evaluated to exclude anatomic abnormality

What are the prophylactic agents?
1. Trimethoprim- sulfamethoxazole
2. Nitrofurantoin
3. Cephalexin
Single dosing at bedtime at time of intercourse

Patient education: hygiene, hydration, and post-coital voiding habits

What is the difference for bacteria that cause acute cystitis and acute pyelonephritis?

Gram negative bacteria (MC)

-E.coli, proteus, klebsiella, enterobacter, and pseudomonas

What is acute pyelonoprhitis?

Infection of renal parenchyma and pelvis

Presentation for pyelonephritis?

Fever, shaking chills, flank pain, irritativie voiding symptoms (urgency, frequency, dysuria), N/V, diarrhea Fever, tachycardia, pronounced CVA tenderness

What are the labs for acute pyelonephritis?

UA: pyruria, bacteriuria, hematuria, white cell casts CBC: leukcytosis and left shift (High WBC) Blood and urine culture: positive for offending agent

What are the complications from pyelonephritis?

Sepsis w/ shock Inadequate therapy-> abscess Diabetic-> emphsematous pyelonphritis

What is the outpatient treatment for pyelonephritis and who is eligible?

Non-pregnant, compliant patients w/ mild uncomplicated disease Close f/u PO abx, pain control, close follow up ``` Fluorquinolones: levofloxacin Amoxicillin-clavulanate Trimethoprim-sulfamethoxazole 14 days Amoxicillin-clavulanate 14 days ``` Remember that fevers may persist for 72 hours even w/ appropriate abx

What is mandatory in the treatment of pyelonephritis?

Follow up urine cultures: confirm eradication of the offending agent

What are the admission requirements for pyelonephritis?

Sepsis, parenteral abx, imaging ``` Obstructive uropathy DIABETICS Renal failure Pregnant Uncontrolled symptoms (treated outpatient, but symptoms haven’t resolved) ```

What do you do for a patient w/ pyelonephritis that has been treated outpatient, but has a failure to respond to treatment w/in 48 hrs?

Order imaging (CT or US)

IV treatment meds for pyelonephritis?

Ampcillin gentimycin (until cultures return) Then ceftriaxone, levofloxacin, piperacillin-tazobactam Continue IV abx for 24 hrs after fever resolves then switch to oral MINIMUM TREATMENT TIME IS 2 WEEKS

What is interstitial cystitis?

Painful bladder syndrome Diagnosis of exclusion, negative urinalysis, culture, and cytology w/ no other causes

Who is MC affected by interstitial cystitis?

Women around 40

What is the cause of interstitial nephritis?

The GAG layer is disrupted and irritants enter the underlying nerve and muscle tissue

What is the ulcer that occurs in the bladder w/ interstitial cystitis?

Hunner’s ulcer

What is the primary complaint of intersitital cystitis?

Pain w/ bladder filling that is RELIEVED W/ URINATION or urgency, frequency, nocturia Makes sense because the pee is irritating

What are causes if intersitital nephritis?

Pelvic radiation, treatment of cyclophosphamide, genital herpes, vaginitis, urethral diverticulum RULE THESE OUT FiRST

What are the tests for interstitial cystitis?

Urodynamic testing for bladder sensation and compliance, and detrusor instability Cystoscopy w/ biopsy

What is the treatment for interstitial cystitis?

Symptomatic Hydrodistension Amitriptyline Intravesical diimethysulfoxide Transcutaneous electric nerve stimulation Acupuncture LAST RESORT: SuRGERY, cystourethrectomy w/ urinary diversion

What is urethritis?

Infection of the urethra w/ gonococcal or non-gonococcal - chlamydia - trichomonas - ureplasma - herpes Most are sexually transmitted!!

What is the presentation for urethritis?

``` Young, sexually active Urethral discharge (mucoid, purulent: gonorrhea) ``` Obstructive voiding symptoms Asymptomatic

What can be a result of chronic urethritis?

Urethral stricture

What is the evaluation for urethritis?

Urethral culture Urine nucleic acid amplification test Test for other STI

What is the treatment for urethritis?

Chlamydia azithromycin 1 g orally Doxycycline 7 days Gonorrhea: (TREAT CHLAMYDIA PRESUMPTIVLEY) Ceftriaxone 250mg IM (Azithromycin, doxycycline)