pyelonephritis

Question 1

uti protective factors

Answer 1

pH = acidic
Presence of urea
Sex-specific factors:
Men = prostatic secretions
Women = urethral gland secretions
Urine flow is uni-directional!
One-way valve at ureteral attachment to bladder
Immune system

Question 2

uti risk factors

Answer 2

Catheterization: CAUTIs
Sex = female 
Perineal irritation
Age = increases
Nursing home up to 50% have bacteriuria
Pregnancy
Sexual activity
severe constipation - like a compaction
Spermicide use with diaphragm or condom 
¼ sexually active women – 1/year
Urinary obstruction or reflux
Immobility
Incontinence 
Urine or stool
Decreased cognition
Bad personal hygiene

Question 3

which bacteria is the main cause of UTI

Answer 3

E. coli

Question 4

pathogenesis of UTI

Answer 4

Ascending Pattern - start at the bottom (entrance to urethra)

Kidney (Pyelonephritis)
Ureter
Bladder (cystitis)
Urethra
Contaminated Perineum

Question 5

description of upper UTI (pyelonephritis)

Answer 5

Pyelonephritis = inflammation of the kidneys
Etiology:
Ascending infection with E. coli
Bloodstream infection

Major risk factor:
Pregnancy, blocked ureter, urinary stasis
Pathogenesis:
Inflammatory response → kidney tissue damage - kidney failure

urine- opaque and foul

Question 6

upper UTI clinical manifestations

Answer 6

Sudden onset:
Fever
Chills
CVA tenderness - palpable flanks and kidneys
Lower UTI symptoms (dysuria)

Accompanying symptoms:
N/V
Anorexia

Question 7

what is urosepsis

Answer 7

Definition:
Severe systemic response to UTI

Who is at high risk?

• Elderly patients
• Diabetics
• Immunosuppressed patients

Prognosis
- High mortality

**is treatable if caught quickly

Question 8

UTI pharm - ABX

Answer 8

Abx for community-acquired infections:
Single-dose
Short-course (3 days)
Conventional (7-14 days)
**not at risk for drug resistance

Treatment varies depending on:
Upper vs. Lower UTI – upper more aggressive tx
Complications
Pregnancy- must worry about fetus and limit ABX
usage
Culture and sensitivity - UA

Question 9

what are the first line ABXs for UTI?

Answer 9

Drug: Ciprofloxacin (Cipro)
MOA: Inhibits bacterial reproduction, works locally
- risk tendon rupture, joint pain and disease

Vancomycin - for more complex/complications

• risks:
• • redman syndrome - fusion too fast
• • ototoxicity
• • kidney issues
• • thrombocytopenia

bactram