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CDM 3 Exam 2 > Lecture 11 - UTI > Flashcards

Lecture 11 - UTI Flashcards

1
Q

How to pathogens generally get into body to get UTI?

A

Mostly ascending, common up from urethra

Descending not common

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2
Q

Host defense mechanisms of UTI

A

Anatomy
Pee power = urination
pH of Urine
Mobilization of PMNs

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3
Q

Lower Tract infection

A

Cystitis, Bladder

Signs & symptoms:
Dysuria, urgency, frequency, nocturne, and suprapubic heaviness

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4
Q

Upper Tract infection

A

pyelonephritis, Kindeys

Signs & Symptoms:
Flank pain, Costovertebral angle tenderness, fever, nausea, vomiting, malaise

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5
Q

What is an uncomplicated infection?

A

no structural or functional abnormalities
Not preggo
No urologic instrument
Premenopausal age

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6
Q

What is complicated infection?

A

complex anatomy ie Male*
Catheter placement

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7
Q

Risk factors for UTI

A

Catheterization = biggest risk
Gender
Age
Sexy time
Diaphragm/spermicide use
Hx of UTI
renal disease
diabetes
drugs

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8
Q

UTI diagnosis?

A

Urinalysis and Urine culture

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9
Q

When should you collect urine?

A

Mid stream is what you want

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10
Q

What to look for on UA for UTI?

A

Bacteria = present
WBC > 10, indicates pyuria/inflammation

Squamous Epithelial high amount (> 4)= contamination sample

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11
Q

What to look for on Urine culture for UTI?

A

Significant bacteriuria = > 10,000 CFU

Less likely UTI of < 10,000 CFU

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12
Q

Situations in which lower colony counts may be sig include…

A

pts who already on abx on time of culture
Symptomatic young women
Suprapubic aspiration
Men with pyuria ( 10+ WBC per cubic mL)

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13
Q

Acute uncomplicated Cystitis 1st line rec

A

Nitro 100mg BID 5 days
Bactrim DS BID 3 days (dont use if resistance > 20%)
Fosfomycin 3g Daily 1 day

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14
Q

Acute uncomplicated Cystitis alternatives

A

FQ: ofloxacin, cipro, levo = 3
B lactam = amox/clav, cefdinir, cefaclor, cem/pro = 3-7 days

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15
Q

Nitro clinical pearls

A

dont use CrCl < 30
dont use pyelonephritis

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16
Q

fosfomycin clinical pearls

A

single dose
dont use pyelonephritis

17
Q

Bactrim clinical pearls

A

Hyperkalemia
Sulfa allergy

18
Q

Fluoroquinolone clinical pearls

A

QTc prolongation
Seizure risk
Moxi = dont get renally cleared so dont use

19
Q

if you get < 3 episodes of UC cystitis then….

A

treat as separately occurring infection

20
Q

If you get > 3 episodes/yr or 2 episodes/6 months treat as Relapse or Reinfection

A

Relapse: same organism and susceptibility, extend ABX duration

Reinfection: different pathogen/strain, retreat and consider prohlyaxis

21
Q

Prophylaxis of Reinfection UTI post sex treatment

A

Bactrim
Nitro
Cephalexin
Cipro

All for one dose

22
Q

Prophylaxis of reinfection UTI unknown cause

A

6 month treatment

Bactrim QD or TIW
Nitro QD
Cephalexin QD
fosfomycin q10 days

if infection occurs, switch to therapy and then back to prophylaxis

23
Q

Complicated Cystitis treatments

A
  1. get urine culture & use susceptibilities

Durations: varies

24
Q

Pyelonephritis Outpatient Mild-moderate txm

A

Levo 750 = 5 days
Cipro 1000 or 500 BID = 7
Bactrim DS BID = 14

IF > 10% resistance to FQs, give 1 dose of IV ceftriaxone or AG

25
Q

Pyelonephritis Inpatient Severe Txm

A

Ceftriaxone**
AGs
Cefepime
Pip/tazo
Carbapenem
FQs

7-14 days, IV -> PO when stable

26
Q

Asymptomatic Bacteriuria info

A

if no symptoms then shouldn’t use Abx

Exceptions: preggo, urological procedure w/ anticipated bleeding

27
Q

Risk of untreated ASB (asymptomatic Bacteriuria) in preg

A

potential to cause serious adverse effects, prematurity, low birth weight and still birth

28
Q

UTI in pregnancy treatments

A

Amox
Amox-clav
Cephalexin

Babies love beta lactams = 4-7 day treatment

Avoid nitro at term. Avoid Bactrim at 1st term and post 38week
Avoid Tetracyclines & FQs***

Premature brith = primary risk

29
Q

Prostatitis symptoms

A

Acute: fever, chills, malaise, tenderness, myalgia
Chronic > 3 months difficulty peeing, lower back pain, discomfort

30
Q

Prostatitis treatment

A

Bactrim, cipro, levo

Acute = 2-4weeks, Chronic = 4-6wks chronic

** Avoid Nitro **

31
Q

Candiduria treatment

A

Fluconazole 200 Daily

Likely related to catheterization…remove and re-eval
0 days most patients, 7-14 days if treating

32
Q

Urinary Aanalgesics Phenazopyridine

A

Common ADRs: red/orange discoloration
Indication: Max of 2 days

Dont use CrCl < 50, can mask symptoms UTI

33
Q

Preventive Care for UTI

A

Better hydration
Pee after sex

Cranberry juice = sus evidence
Lactobacillus = probiotic

CDM 3 Exam 2 (11 decks)

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