Infections Of Adult Urinary Tract Flashcards
What should you consider in any children w/ a UTI prior to toilet training?
Vesicoureteral reflux
VCUG and refer
If a child has a fever what should be on your differential?
UTI
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)
Female UTI risk factor?
Short urethra
Male uti risk factor?
Increased incidence if uncircumcised and insertive anal intercourse
What are general UTI risk factors?
Retentiion (obstruction, BPH, stones, pregnancy) , stasis, reflux
Diabetes
Foreign bodies
What is the MC route of UTI?
Ascending infection from the urethra
What is the MC route for pyelonephritis?
Ascent of infection up the ureter
Acute UTIs are caused by how many pathogens?
1
Chronic UTIs are caused by how many pathogens?
2 or more pathogens
What is the MC cause of an uncomplicated UTI?
Ecoli (ascending poop)
What is the MC cause of nosocomial or hospital acquired UTIs?
Pseudomonas and staphylococcus
What is the treatment for asymptomatic bacteriuria?
No treatment UNLESS
Pregnancy
Invasive urologic procedure (catheter, imaging)
What is acute cystitis?
Bladder infection from coliform bacteria and gram positive bacteria
What is cystitis common presentation?
Irritating voiding (frequency, urgency, dysuria)
Gross hematuria
Symptoms following intercourse
Suprapubic tenderness
What patient would you consider imaging for in cystitis?
Male patients
What would your labs look like for cystitis?
UA: Pyuria, bacteriuria, hematuria
Urine culture
Who is an uncomplicated UTI?
Acute cystitis in an otherwise health NONPREGNANT adult woman
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)
