Infectious Diseases

Question 1

classic sxs of UTI

Answer 1

• dysuria- frequency- urgency

Question 2

sx and sign seen in about 1/2 of pts w/ pyelonephritis

Answer 2

• flank pain- fever

Question 3

risk factors for UTIs in WOMEN

Answer 3

• DM- sexual activity- diaphragm use- vaginal atrophy- genetic predisposition

Question 4

when is sexual activity a risk factor in MEN?

Answer 4

MSM

Question 5

risk factors for UTIs in HETEROSEXUAL MEN

Answer 5

• obstruction- ureterovesical reflux- prostatic hypertrophy

Question 6

what are the MOST COMMON nosocomial infections?

Answer 6

UTIs

Question 7

risk factors for UTIs in EITHER gender

Answer 7

• DM- SCD- renal stones

Question 8

what bug is specifically associated w/ urinary stones?

Answer 8

Proteus

Question 9

when Proteus is identified in the urine (UTI), what should be done next?

Answer 9

imaging test to look for stones

Question 10

group B strep (S. agalactiae) UTI is seen in

Answer 10

pregnancy

Question 11

diagnosis for UTI

Answer 11

• urine culture growing 100,000 or more of gram-negative organisms- gram-positive organisms or yeast can cause infection with lower colony counts

Question 12

what is a positive urine culture in the absence of sxs called?

Answer 12

NOT a UTI; asymptomatic bacteriuria

Question 13

MC gram-negative organism causing UTI

Answer 13

E. coli

Question 14

MC gram-positive organism causing UTI

Answer 14

Enterococcus

Question 15

uncommon cause for UTI if NO urinary catheter, and should raise concern for what?

Answer 15

• Staphylococcus aureus- bacteremia from another source seeding to the kidney

Question 16

what is the FIRST step in evaluating whether to treat a positive urine culture?

Answer 16

determine if the pt has SIGNS or SYMPTOMS of infection

Question 17

treat ASYMPTOMATIC bacteriuria under ONLY 3 circumstances

Answer 17

1. pregnant women2. pts about to undergo a urologic procedure3. renal transplant recipients w/i the first 3 mos

Question 18

why do you treat asymptomatic bacteriuria in pregnant women?

Answer 18

• prevent progression to pyelonephritis- decrease maternal and fetal morbidity and mortality

Question 19

treatment for asymptomatic bacteriuria in pregnant women

Answer 19

• TMP/SMX during weeks 12-36 ONLY x 3 days- nitrofurantoin x 3 days- cephalexin x 3 days

Question 20

why do you treat asymptomatic bacteriuria in renal transplant recipients?

Answer 20

• decrease r/o a SYMPTOMATIC UTI, which increases risk of rejection

Question 21

w/ SYMPTOMATIC UTIs, what is the next step?

Answer 21

determine if LOWER tract (cystitis), or UPPER tract (pyelonephritis)

Question 22

w/ SYMPTOMATIC UTIs, what is the next step after determining if lower vs upper tract?

Answer 22

complicated or not

Question 23

definition of complicated UTI

Answer 23

• DM- structural anomalies- foreign bodies- prior resistant organisms- immunocompromised- male

Question 24

when do you NOT need a urine culture?

Answer 24

uncomplicated UTI

Question 25

when should imaging be performed in pyelonephritis?

Answer 25

ONLY if sxs PERSIST after 72 hours of culture-guided therapy

Question 26

treatment for uncomplicated cystitis

Answer 26

• 3-day course of:- TMP/SMX- fluoroquinolone- cephalexin

Question 27

treatment for complicated cystitis or UNcomplicated pyelonephritis

Answer 27

• fluoroquinolone- TMP/SMX- beta-lactam- depending on C+S data

Question 28

treatment for complicated pyelonephritis and/or hospitalized pts

Answer 28

• 7-10 days unless bacteremic- fluoroquinolone- ceftriaxone- beta-lactam + beta-lactamase inhibitor- ampicillin + aminoglycoside

Question 29

when should a urinary catheter be changed in UTI?

Answer 29

ONLY if symptomatic

Question 30

recurrent UTIs can be differentiated into what 2 types?

Answer 30

1. RELAPSE (same strain w/i 2 weeks of the end of previous tx)2. REINFECTION (different strain than the initial infection)