Lecture 7: UTIs Flashcards
What is the MC organism to cause an UTI?
E. Coli
How does the etiology of an acute UTI vs a chronic UTI differ?
- Acute UTI: typically one organism.
- Chronic UTI: 2+ organisms
What two diagnostic tests are suggestive of an UTI?
- Colony count > 10^5 cfu/mL
- Pyuria
Both are not diagnostic of UTI.
What is considered asymptomatic bacteriuria in women?
2 consecutive specimens with colony counts > 10^5
MC in women of increasing age.
Not recommended to screen in women or children.
What could result in unresolved bacteriuria?
- Resistance
- Noncompliance
- Mixed infections
What is a persistent bacteriuria?
Sterilized urinary tract but still recurs due to persistent sources of bacteria.
- Infected stones
- Prostatitis
- Foreign bodies
- Fistulas
What is the most common spreading method of UTIs?
Ascending via the urethra.
Women have higher incidence due to a much shorter urethra.
If an UTI has a hematogenous source, what is the most likely bacteria to cause it?
Staph Aureus
What are some general risk factors for UTIs?
- Abnormal voiding
- Diminished renal blood flow
- Intrinsic renal disease
- Abnormal urine pH or osmolality
- Deficient mucosal coating
What is the primary etiology of acute cystitis?
Bacterial (E. coli)
What is the MC route for contracting acute cystitis?
Ascent up the urethra
What are the S/S of acute cystitis?
- Irritative voiding
- Suprapubic pain
- +/- hematuria
- +/- malaise
- Suprapubic tenderness
Systemic symptoms should NOT BE SEEN.
CVA tenderness would be more suggestive for pyelo.
What is the triad that makes up irritative voiding?
- Dysuria
- Frequency
- Urgency
What imaging should we use for acute cystitis?
None needed unless male or complicated.
Could consider US for a male
What are the expected lab results for acute cystitis?
- Pyuria, hematuria, bacteriuria.
- Leukocyte esterase, urinary nitrite
- Urine culture
UA is NOT required unless risk factors or systemic symptoms present.
What are the risk factors that would make an MDR G- bacteria more likely to be the underlying etiology for acute cystitis?
- Infection in 3 months with MDR G-
- Inpatient stay
- International travel
- Quinolone, TMP-SMZ, or ES-beta lactam abx in 3 months.
What is the empiric therapy for acute cystitis?
- 5 days of macrobid 100mg BID
- 3 days of bactrim DS 800/160mg BID
- 1 dose of fosfomycin 3g
Can choose any of these.
Macrobid only works on bacteriuria specifically.
DS = double strength
What are the second-line empiric therapies for acute cystitis?
- Augmentin or cefdinir/cephalexin for 5-7days BID
What are the 3rd line therapies for acute cystitis?
Fluoroquinolones
What would prompt us to order a repeat UA for acute cystitis?
Only if we are concerned it is unresolved.
What drug/dye can be given as a urinary analgesic and its main concerns?
- Phenazopyridine (dye)
- Not for chronic use
- Affects UA
- Can cause AKI, hemolytic anemia, or methemoglobinemia
Can make urine bright orange! (prob a test question)
Should not use past 2 days!!!!!!!!!
What drug can double as a urinary analgesic and antimicrobial? What is its MOA?
- Converts parts of urine to formaldehyde and ammonia.
- Methenamine
Usually short-term
What are the SEs/CIs associated with methenamine?
- Sulfa allergy
- Rash
- Nausea
- Dyspepsia
- CI in renal/liver insufficiency
What is a sitz bath?
Sitting in a shallow basin filled with warm water.
What are the non-pharmacologic interventions for acute cystitis?
- Pee after sex
- Pee when you can
- Drink enough water so you pee
- Wipe your pee front to back
- Probiotics, cranberry juice, D-mannose
SGLT2 inhibitor could increase incidence of UTIs! (anything that ends in gliflozin?)
What would prompt us to use abx prophylaxis for acute cystitis and the options?
- 3+ UTIs in a 12-month period with no correctable etiology.
- Bactrim, TMP, Macrobid, Keflex, Methenamine (BID)
All other abx are daily.
What is the primary difference between acute cystitis vs pyelo?
Pyelo is more referred to as a kidney infection, rather than an UTI.
Same etiology, same route, same demographics
It is rare than acute cystitis (since it is essentially a more advanced version of it)
What S/S are more unique to pyelo vs cystitis?
- Fever
- CVA tenderness
- N/V/D
- Flank pain
- Tachycardia
What is the preferred imaging modality for pyelo if imaging is desired?
CT, because it can show inflammation.
Overall, imaging is not required to diagnose.
Both US and CT can show abscess.
What are the expected labs for pyelo?
- Pyruia, hematuria, bacteriuria
- WBC casts can appear
- Leukocyte esterase, urinary nitrite
- CBC will show leukocytosis with left shift (DIFFERENT FROM CYSTITIS)
Generally labs appear the same as they do in cystitis
For OP tx of pyelo, what are the primary abx options?
- Initial IV of rocephin, cipro, or gentamicin
- Oral ABX: Levofloxacin, cipro, Bactrim DS
- 5-7 days for fluoros, 14 days for others.
Augmentin is second line.
DO NOT USE MACROBID OR FOSFOMYCIN!!!!!!!!!!!!!!!!!!!!!!!!!!!!
For IP empiric tx of pyelo, what are the primary abx options?
- If no MDR G- risk: rocephin, zosyn, unasyn, or fluoroquinolones
- 1+ MDR G- risk: carbapenems
- For highly resistance MDR G-: ES cephalosporin + BL inhibitor
- For MDR G+: vanco, linezolid, or daptomycin
14d of tx
DO NOT USE MACROBID OR FOSFOMYCIN!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
Zosyn has a z, so its pip/taZo
Unasyn has a u, so its amp/sUl
What are the complications associated with pyelo?
- Sepsis/shock
- Scarring and nephron loss
- Chronic pyelo (3-6 months of abx)
- Abscess formation (might need I&D)
What are the primary etiologies for acute urethritis?
- N. gonorrhea
- Chlamydia
- Mycoplasma genitalium
- Trichomonas vaginalis
Usually either gonococcal or non.
What is different about demographics between urethritis vs cystitis/pyelo?
MC in men because urethra is long enough to become infected.
In women, urethra is short so infection goes to bladder asap.
What are the S/S of acute urethritis?
- Irritative voiding
- Pain/itching at meatus
- Urethral discharge
If a patient has thick, purulent, copious discharge from their urethra, what is the more likely causative organism?
Gonorrhea
Will usually require milking the urethra. (awk)
What are the labs that would suggest urethritis?
- Gram stain
- > 2WBC/hpf = presumptive
- G- intracellular diplococci: presumed gonococcal
- NAAT - diagnosing gono/chlamydia
- UA: WBC esterase, pyruia, possible hematuria (need first-stream sample)
AKA you do not want them to pee out the first bit into the toilet. Different from a clean catch!!
What is the empiric tx for acute urethritis?
- Gono: rocephin
- Chlamydia: azithromycin, but doxy is preferred (but it is 7 days only)
MUST TREAT ALL PARTNERS AND REPORT TO HEALTH DEPARTMENT
If very low risk for STI, should do a C&S in case.
