Infectious Diseases Flashcards
What are the most common bugs that cause UTIs?
- E. coli
- Staph saprophyticus
- Enterococcus
- Klebsiella
- Proteus spp
- Pseudomonas
- Enterobacter
- Yeast
What does a positive urine leukocyte esterase test indicate?
Pyuria
What does a positive urine nitrate test indicate? What are it’s limitations?
Bacteria, but only tests the presence of gram-negative bacteria (enterobacteriaceae)
What does it indicate if epithelial cells are found on a UA? What is the next step?
Vulvar or urethral contamination; repeat UA through bladder catheterization
What are (3) reasons that would a urine culture would be indicated?
- Symptoms are not characteristic of a UTI
- Complicated infection is suspected
- Symptoms persist despite abx treatment
What are the parameters that would suggest a complicated UTI?
- UTI spreads beyond the bladder (pyelonephritis, prostatis)
- UTI caused by structural abnormalities, metabolic disoder, or neurologic dysfunction
What groups of patients are considered to be having a complicated UTI?
- Men
- Diabetics, renal failure
- Pregnancy
- Hx of pyelonephritis in last year
- Urinary tract obstruction, indwelling catheter, stent, nephrostomy tube
- Abx-resistant organism
- Immunocompromised patients
What are the treatment options in acute uncomplicated cystitis?
- TMP/SMX (Bactrim) x3d
- Nitrofurantoin x5-7d; CI in pyelonephritis
- Fosfomycin x1 dose; CI in pyelonephritis
- Amoxicillin
- Fluroquinolones / ciprofloxin x3d
What is phenazopyridine used for in UTI treatments?
Urinary analgesic given for 1-3d for dysuria
What treatments are used in pregnant women with UTIs? What is contraindicated?
Ampicillin x7-10d
Amoxicillin x7-10d
Oral cephalosporins x7-10d
AVOID: fluoroquinolones - may lead to fetal arthropathy
How are men with UTIs treated?
Same as uncomplicated acute cystitis, but treat for 7d
What are the next steps for someone presenting for UTI within 2 weeks of the most recent UTI?
Continue treatment for 2 more weeks and obtain a urine culture
What are the most common organisms that cause pyelonephritis?
- E. coli
- Proteus
- Klebsiella
- Enterobacter
- Pseudomonas
- Enterococcus faecilis (gram +)
- Staph aureus (gram +)
What is a complication of pyelonephritis seen in diabetics?
Emphysematous pyelonephritis caused by gas-producing bacteria
What are the signs and symptoms of pyelonephritis?
Symptoms: fever, chills, flank pain, n/v/d
Signs: fever w/tachycardia, CVA tenderness, abdominal tenderness
What are the diagnostic tools used in pyelonephritis? What may be seen on those tests?
- UA - pyuria, bacteriuria, leukocyte casts, hematuria, proteinuria
- Urine culture
- Blood cultures
- CBC - leukocytosis w/ left shift
- Renal function - usually preserved, reversible
- Imaging studies - US, CT, IVP, retrograde ureterogram
What treatment is normally indicated for the following causes of pyelonephritis:
Gram-negative rod
Gram-positive cocci
- TMP/SMX or fluoroquinalone x10-14d
2. Amoxicillin
What is a suspected cause of pyelonephritis is symptoms fail to respond to abx?
Structural or functional abnormality
What changes in the treatment of pyelonephritis occur if the patient is very ill, elderly, pregnant, or unable to tolerate oral meds?
- Admit and give IV fluids
- Abx - start with ampicillin + gentamycin or ciprofloxacin
- If (-) blood culture, treat IV abx until afebrile 24h, switch to oral for 14-21d
- If (+) blood culture indicating urosepsis, treat IV abx for 2-3 wks
How long is recurrent pyelonephritis treated if it’s from the same organism? Different organism?
Same: 6 weeks
Different: 2 weeks
