Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PR3151 > Management of UTI > Flashcards

Management of UTI Flashcards

1
Q

What is asymptomatic bacteriuria?

A

Defined as isolation of significant colony counts of bacteria in the urine (bacteriuria) from a person w/o UTI symptoms (asymptomatic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

When is screening of asymptomatic bacteriuria indicated?

A
  1. Pregnant women - ~12-16 weeks gestation
  2. Patients going for urologic procedure where mucosal trauma/bleeding is expected - 2-3 days prior to procedure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Why is asymptomatic bacteriuria screened for in pregnant women?

A

Prevent pyelonephritis (risk increases by 20-30 fold), preterm labour and low infant birth weight

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What should be done if a pregnant woman’s urine sample comes back positive for asymptomatic bacteriuria?

A

Treat w active antibiotics based on AST for 4-7 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Why is screening of asymptomatic bacteriuria done for urologic procedures?

A

Prevent bacteremia and urosepsis from bacteria moving to the bloodstream

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What urologic procedure that causes trauma to the mucosal lining DOES NOT need asymptomatic bacteriuria testing?

A

Urinary catheter placement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the possible routes of infection for a UTI?

A

Ascending route and Descending route

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the likely pathogens to be found for a UTI caused by the ascending route?

A

Gut flora - E.coli, Klebsiella spp, Proteus spp

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Why are adult females more predisposed to getting UTIs than men?

A

Shorter urethra
Possible use of spermicides and diaphragms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

When would descending route of UTI pathogenesis be suspected?

A
  • Non-GI bacteria appear in the culture
  • Patient has bacteremia
  • Patient has another primary infection going on
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the factors determining the development of a UTI?

A

→ Bacteria in bladder stimulates urination – emptying bladder gets rid of morebacteria
→ Antibacterial properties of urine and prostatic secretions
→ Anti-adherence mechanisms of bladder to prevent bacterial attachment to bladder
→ Inflammatory response with polymorphonuclear leukocytes (PMNs) – carry out phagocytosis to prevent/control spread of bacteria
→ Size of Inoculum – increases w obstruction/urinary retention
→ Virulence/Pathogenicity of Microorganism (Eg bacteria w pili are resistant to washout or removal by anti-adherence mechanisms of bladder as they have an even better ability to adhere)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

List 5 ways to prevent a UTI.

A
  • Drink more fluid to flush bacteria – drink as much as possible/as comorbidities allow
  • Urinate frequently, go when got urge – bacteria can grow when urine stays in bladder for too long
  • Urinate shortly after sex – can flush away bacteria that might have entered urethra during sex
  • Women should wipe front to back to avoid spreading bacteria from anal area to urethral area
  • Wear cotton underwear and loose-fitting clothes so that the area remains dry
  • Avoid tight-fitting jeans and nylon underwear – trap moisture, promote bacterial growth
  • Consider changing to birth control other than diaphragms and spermicides
  • Cranberry juice
  • Intravaginal estrogen cream (controversial) – restore vaginal flora, prevent E. coli colonisation
  • Lactobactillus probiotics (evidence not reliable yet) – restore normal vaginal flora, protect against E. coli
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

When is a UTI considered complicated?

A

→ Men, children, pregnant women
→ Presence of complicating factors: functional and structural abnormalities of urinary tract, genitourinary instrumentation, diabetes mellitus, immunocompromised host

(uncomplicated - premenopausal, non-pregnant women w normal urinary tract)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the risk factors for a UTI? List at least 8.

A

→ Female > Male (urethral length)
→ Sexual intercourse
→ Abnormalities of the urinary tract eg prostatic hypertrophy, kidney stones, urethral strictures, vesicoureteral reflux
→ Neurologic dysfunctions eg stroke, diabetes, spinal cord injuries
→ Anti-cholinergic drugs (dec bladder contractility, resulting in voiding becoming less frequent)
→ Catheterisation and other mechanical instrumentation (biofilm/colonisation)
→ Diabetes
→ Pregnancy
→ Use of diaphragms and spermicides
→ Genetic association
→ Previous UTI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the symptoms of lower urinary tract infection/cystitis?

A

Dysuria, urgency, frequency, nocturia, suprapubic heaviness or pain, gross haematuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the distinguishing factors of pyelonephritis from cystitis?

A

Most obvious: flank pain, costovertebral tenderness (renal punch)

Others: Fever, rigors, headache, nausea, vomiting, malaise, abdominal pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the potential lab tests to diagnose UTI?

A

UFEME, Dipstick (Nitrite, Leukocyte Esterase), Cultures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the cut off number of white blood cells in a urine sample for pyuria?

A

> 10 WBC/mm3

19
Q

What does pyuria indicate in UTI?

A

Signifies presence of inflammation

In a patient symptomatic for UTI, pyuria is correlated w significant bacteriuria

20
Q

What would a positive nitrite dipstick indicate for a UTI patient?

A

Presence of gram-negative bacteria

21
Q

Why can a false negative nitrite dipstick test occur?

A

False-negatives can occur due to presence of Gram-positives, P.aeruginosa, low urinary pH, frequent voiding and dilute urine

22
Q

What does a positive leukocyte esterase dipstick indicate for UTI?

A

Positive test indicates esterase activity of leukocytes in urine, correlates w significant pyuria

23
Q

When are urine cultures needed for UTI?

A
  • Pregnant women
  • Recurrent UTI (relapse within 2 weeks, frequent UTI)
  • Pyelonephritis
  • Catheter-associated UTI
  • Male UTI
24
Q

What are the likely pathogens for uncomplicated, community-acquired UTI?

A

→ Escherichia coli (>85%)
→ Staphylococcus saprophyticus (5-15%)
→ Others: Enterococcus faecalis, Klebsiella pneumoniae, Proteus spp

25
Q

What are the likely pathogens for complicated UTI?

A

→ E. coli (~50%)
→ Enterococci
→ Proteus spp, Klebsiella spp, Enterobacter spp, P.aeruginosa

26
Q

What are the likely pathogens for healthcare-associated UTIs?

A

→ E. coli (~50%)
→ Enterococci
→ Proteus spp, Klebsiella spp, Enterobacter spp, P.aeruginosa

27
Q

What are the first-line empiric regimens for uncomplicated cystitis in women?

List the route, drug, dose, frequency and length of regimen.

A

PO Co-trimoxazole 800/160mg BD for 3/7
PO Nitrofurantoin 50mg 4 times/day for 5/7
PO Fosfomycin 3g as a single dose
(every other day for 3 doses if complicated)

28
Q

What are the alternative empiric beta-lactam regimens for uncomplicated cystitis in women?

List the route, drug, dose, frequency and length of regimen.

A

PO Cefuroxime 250mg BD
PO Augmentin 625mg BD
PO Cephalexin 250-500mg 4 times/day

All 5-7 days

29
Q

What are the alternative empiric non-beta-lactam regimens for uncomplicated cystitis in women?

List the route, drug, dose, frequency and length of regimen.

A

PO Ciprofloxacin 250mg BD
PO Levofloxacin 250mg OD

Both for 3 days

30
Q

What are the therapeutic options for empiric treatment of community-acquired pyelonephritis by PO?

A

PO Co-trimoxazole 800/160mg BD 10-14/7
PO Ciprofloxacin 500mg BD 7/7
PO Levofloxacin 750mg OD 5/7
PO Cefuroxime 250-500mg BD 10-14/7
PO Augmentin 625mg TDS 10-14/7
PO Cephalexin 500mg 4 times/day 10-14/7

31
Q

What are the therapeutic options for empiric treatment of community-acquired pyelonephritis by IV?

A

IV Ciprofloxacin 400mg BD OR
IV Cefazolin 1g Q8H OR
IV Augmentin 1.2g Q8H

Can add IV/IM Gentamicin 5mg/kg

32
Q

What are the therapeutic options to treat UTI in men that have no concern for prostatitis?

A

Same as complicated cystitis in women

33
Q

What are the therapeutic options to treat cystitis in men with concern for prostatitis?

A

PO Ciprofloxacin 500mg BD
PO Co-trimoxazole 800/160mg BD

Both for 10-14 days, increase to 6 weeks if prostatitis is confirmed

34
Q

What are the IV empiric regimens for healthcare-associated UTI?

A

IV Cefepime 2g Q12H ± IV Amikacin 15mg/kg/d
IV Imipenem 500mg Q6H
IV Meropenem 1g Q8H

All for 7-14 days
Escalate if patient doesn’t get better after 2 days

35
Q

What are the PO empiric regimens for healthcare-associated UTI?

A

PO Levofloxacin 750mg OD
PO Ciprofloxacin 500mg BD

Both for 7-14 days

36
Q

What are the symptoms of catheter-associated UTI?

A
  • New onset or worsening of fever, rigors, altered mental status, malaise or lethargy with no other identified cause, flank pain, costovertebral angle tenderness, acute haematuria, pelvic discomfort
  • If patient is stable and fever is still low grade, consider observation rather than immediate antibiotics therapy
37
Q

How can catheter-associated UTI be prevented?

A
  • Avoid unnecessary catheter use
  • Use for minimal duration
  • Change long-term indwelling catheters before blockage is likely to occur
  • Use of closed system
  • Ensure aseptic insertion technique
38
Q

What are the empiric regimens for catheter-associated UTI?

A

IV Imipenem 500mg Q6H 7/7
IV Meropenem 1g Q8H 7/7
IV Cefepime 2g Q12H 7/7 ± 1 dose IV Amikacin 15mg/kg/d
Mild cases: PO/IV Levofloxacin 750mg OD 5/7
Women >65yo w/o upper urinary tract symptoms: PO Co-trimoxazole 800/160mg BD 3/7

39
Q

What antibiotics should be avoided for treating UTI in pregnant women in all trimesters?

A

Ciprofloxacin (fetal cartilage damage and arthropathies in animal studies)
Aminoglycosides (use w caution, 8th cranial nerve toxicity in fetuses reported)

40
Q

Which trimesters should co-trimoxazole be avoided during pregnancy for treatment of UTI?

A

1st and 3rd

41
Q

What antibiotics should be avoided for treating UTI in pregnant women in the 3rd trimester?

A

Co-trimoxazole, nitrofurantoin

42
Q

How long does it usually take for an improvement in UTI symptoms to appear after initiating effective antibiotic therapy?

A

2-3 days

If it takes longer than 2-3 days, need to do further investigations

43
Q

Should repeat urinary cultures be done for a patient who has recovered from UTI?

A

Not needed

Only required in pregnant women to document clearance of infection

PR3151 (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions