Infectious Disease: Genitourinary Flashcards
Lower UTI Laboratory Tests
Bacturia, Pyuria, Nitrate (+)
Leukocyte Esterase (+)
Upper UTI Laboratory Tests
Leukocytosis, Hyaline Casts (UA)
Uncomplicated UTI Criteria
Females of childbearing age
Age 15-45
No structural/neurological abnormalities interfering w/ urine flow
Complicated UTI Criteria
Don’t meet any of the uncomplicated criteria
Community Acquired Microbiology Uncomplicated
Gram-Negatives
Gram-Positives
E.coli
Klebsiella pneumoniae
Proteus spss
Staphylococcus saprophytiicus
Enterococcus
Community Acquired Microbiology Complicated
Gram-Negatives
Gram-Positives
E.coli
Proteus spss.
other GN
Staphylococcus saprophytiicus
Enterococcus
Nosocomial Microbiology
Gram-Negatives
Gram-Positives
Fungal
E. Coli
Proteus spss.
Enterobacter
Acinetobacter
Pseudomonas aeruginosa
Enterococcus
Candida
Cystitis Uncomplicated Treatment
SMZ/TMP 3d
Trimethoprim 3d
Fluoroquinolones (Cipro, Levo) 3 d
Nitrofurantoin 3d
Fosfomycin 1 dose
B-lactams (Amox/Clav) 3d
Pyelonephritis Treatment
Consider hospitalization if?
pt is unable to tolerate PO
Has severe symptoms: high temp, elevated WBC, severe pain, dehydration
No improvement on outpatient therapy
Uncomplicated Pyelonephritis Treatment
Treat empirically with:
If the organism is susceptible -?
If the organism is susceptible -?
If gram-positive is the causative agent?
Duration?
PO cephalosporins
SMZ/TMP
Amoxicillin or Amox/Clav
14d
Complicated Pyelonephritis Treatment
Nosocomial Infections
1st line?
Consider what if no improvement?
Ciprofloxacin or Levofloxacin
Pseudomonas or Enterococcus coverage
Complicated Pyelonephritis Treatment
Agents and Duration?
Gram-positive organisms?
Levofloxacin or Ciprofloxacin 14d
Aminoglycoside +/- Ampicillin 14d
Extended spectrum Cephalosporin 14d
Amp/Sublact +/- AG
Complicated Pyelonephritis Treatment
Possible Alternative Regimens
PCN allergic?
Others?
Aztreonam
B-lactam/B-lactamase inhibitors
Carbapenems
GU Infections
Relapse:
Failed Short course (3 days) treatment is?
Failed Longer course (10-14d) treatment is?
continue same therapy for 14d
continue same therapy for 6 weeks
GU Infections
Re-infection:
Different Pathogen involved treatment is?
treat for 14 days
GU Infections: Catheter Associated Infections
Do we need to treat?
Remove what?
Bags should be drained how often?
Start abx only if? (Treat as what?)
Administering abx to prevent infection is or is not recommended?
the catheter
q4-6h
only if symptomatic; complicated cystitis
not recommended
Genitourinary Infections: Asymptomatic Bacturia
Only time this is treated is in who?
20-40% of this population w/ asymptomatic bacturia will develop what?
Duration for ASB is?
Safest agents/agents of choice is?
pregnant women
pyelonephritis
3-7d
B-lactams
