Mehl. + UW infections urinary (bacteriuria+pyelo) 02-20 (1)

Question 1

UW table. Asymptomatic bacteriuria (ASB) - definition?

Answer 1

growth of ≥100,000 (105) colony-forming units/mL of a single bacterium from a clean-catch urine specimen in the absence of symptoms of a urinary tract infection.

Question 2

UW table. Asymptomatic bacteriuria (ASB). Risk factors?3

Answer 2

Pregestational DM
Hx of urinary infection
Multiparity

Question 3

UW table. Asymptomatic bacteriuria (ASB) - pathogens? 4

Answer 3

MCC - E coli
Klebsiella
Enterobacter
Group B streptococcus

Question 4

UW table. Asymptomatic bacteriuria (ASB) - potential complications? 2

Answer 4

Acute pyelonephritis
Preterm labor and delivery

Question 5

UW table. Asymptomatic bacteriuria (ASB) - Tx? antibiotics lentelej buvo 4 + 2 in text

Answer 5

First line: NITROFURANTOIN (only 2nd term), fosfomycin, TMP-SMX (only 2nd term)
kiti lentelej: Amoxiclav, cefpodoxime

Question 6

UW table. Asymptomatic bacteriuria (ASB) - choice of abs depends on what?

Answer 6

depends on gestational age

Question 7

UW table. Asymptomatic bacteriuria (ASB) - what 2 abs avoid in 1st and 3rd?

Answer 7

TMP-SMX and nitrofurantoin

Question 8

UW. ASB pregnant women have an increased risk for pyelonephritis and complications (eg, preterm delivery, low birth weight) associated with ASB. Therefore what we must do for all pregnant?

Answer 8

Screened for ASB at the initial prenatal visit.
Patients require antibiotic therapy when screening urine cultures are positive.

Question 9

UW. ASB - If contraindications (ie, medication allergies) exist, alternate options include beta-lactams (eg, amoxicillin-clavulanate, cephalexin);

Answer 9

.

Question 10

UW. ASB - Fluoroquinolones (eg, ciprofloxacin)?

Answer 10

contraindicated in pregnancy (fetal bone deformities and arthropathy.)

Question 11

UW. ASB - Doxycycline and other tetracycline?

Answer 11

Contraindicated in pregnancy because they interfere with fetal bone and tooth development. Children exposed to tetracycline in utero can also develop gray discoloration of the teeth.

Question 12

UW. ASB - TMP-SMX?

Answer 12

Safe in 2nd; avoid in 1st and 3rd.

In first - interferes with folic acid metabolism, which is critical to early fetal development.
In third - risk for neonatal kernicterus

Question 13

UW. Pyelonephritis. risk factors? 3

Answer 13

ASB
DM
Age <20

Question 14

UW. Pyelonephritis. pathogens - same as ASB

Answer 14

.

Question 15

UW. Pyelonephritis. Complications? 3

Answer 15

Preterm labor
Low birth weight
ARDS

Question 16

UW. Pyelonephritis. Tx?

Answer 16

Admission + urine culture with sensitivities, and broad-spectrum intravenous antibiotics (eg, ceftriaxone).
Supportive therapy

Question 17

UW. case: typical pyelo + admission + iv abs. After 3 days no symptoms, normal temp. you get sensitivities of e coli. Which form will continue, iv or po?

Answer 17

can transition to pos

Question 18

UW. case: typical pyelo + admission + iv abs. After 3 days no symptoms, normal temp. you get sensitivities of e coli. in case was 34 weeks.
Sensitive to TMP-SMX, nitro, cephalexin. Which one will give (pos)?

Answer 18

cephalexin.
TMP-SMX - contraindicated in 3rd trim
nitro - only for cistitis, ASB. DOES NOT PENETRATE KIDNEY TISSUE, NOT EFFECTIVE IN PYELO!!!

Question 19

UW. pyeolo case. What need to do when Tx is done? (typically requires 5-14 days to completely eliminate bacteria from both the upper (eg, kidney, renal collecting ducts) and lower urinary tract)

Answer 19

pregnant patients also require a repeat urine culture (due to a high risk for persistent bacteriuria) and daily antibiotic prophylaxis (eg, cephalexin) for the remainder of the pregnancy to prevent recurrence.

Question 20

UW. Pyelo. kiti variantai. nitrofurantoin?

Answer 20

Nitrofurantoin and trimethoprim-sulfamethoxazole are commonly used to treat acute cystitis during pregnancy;

Question 21

UW. pyelo. How to confirm Dx?

Answer 21

Diagnosis is confirmed with urinalysis (eg, leukocyte esterase, blood), as in this patient. Urine culture is also performed.

Question 22

Mehl.
- USMLE wants you to know pregnant women are at ­ risk of pyelo due to two main
reasons:
- 1) Progesterone slows ureteral peristalsis, thereby ­ risk of urinary stasis and
backup to kidney.
- 2) Compression of ureter(s) by uterus, notably in 3rd trimester, ­ risk of stasis.

Answer 22

.

Question 23

Mehl. asymptomatic bacteriuria is always treated in pregnancy, even
though it is not treated in non-pregnant women.

Answer 23

Nitrofurantoin is a classic drug used
to treat asymptomatic bacteriuria, standard UTIs, and cystitis in pregnancy.