Pyelonephritis, Cystitis, and Asymptomatic Bacteriuria - Exam 2 Flashcards
what is an acute complicated UTI/Pyelonephritis?
infection of the kidney upper urinary tract (kidneys and ureters)
what is an acute uncomplicated cystitis?
infection of the bladder (lower urinary tract)
what are the most common pathogens for cystitis?
e. coli
what if you see lactobacilli on U/A for cystitis?
it is usually a contamination b/c it is normal vaginal flora
pathogenesis of cystitis?
colonization of the vaginal introitus -> ascends urethra into bladder
could be d/t structural issue (short urethral syndrome)
risk factors for developing UTIs?
recent sexual intercourse, UTI hx, spermicides alone, diaphragms, indwelling catheters, diabetes, structural abnormalities
cystitis signs/sx’s?
Dysuria, Frequency, Urgency, Suprapubic pain, Hematuria
what is the most valuable diagnostic test for cystitis?
U/A
what does a U/A or dipstick detect?
- Leukocyte esterase
- Enzyme released by leukocytes -> reflects pyuria
- Nitrites
Presence of enterobacteria -> converts urinary nitrate into nitrite
-False positives with bladder analgesics (Ex: Phenazopyridine - pyridium)
-WBC, RBC, Protein
do you have to get a urine culture for cystitis?
up to you
cystitis tx?
Macrobid, Bactrim, Cipro
can treat symptomatic female even if UA comes back negative
cystitis tx for symptomatic pt?
Phenazopyridine (pyridium)
why don’t mean get has many UTIs as women?
structural differences
-have longer urethras than women
risk factors for men getting UTIs
insertive intercourse (insertive partner usually gets the UTI) and uncircumcised men
what structures does pyelonephritis involve?
the kidney parenchyma and renal pelvis
most common pathogen for pyelonephritis?
E. coli
other pathogen for pyelonephritis? (HINT: think common in healthcare)
pseudomonas -> someone with indwelling catheter
pathogenesis of pyelonephritis?
- Begins with colonization of the vaginal introitus with fecal flora
- Ascends into bladder, ureters, kidney
- Can have seeding from bacteremia
pyelonephritis signs and sx’s
UTI sx’s but more body sx’s - these people are much more sick!!!
Dysuria, Frequency, Urgency, Suprapubic pain, Hematuria
Fever, Chills, Flank pain, CVA tenderness, Nausea/Vomiting
pyelonephritis labs?
U/A, urine culture, CBC (elevated w/left shift)
Blood cx - sepsis
imaging for pyelonephritis?
none unless think there is a renal mass, then get renal US
indications for hospitalizations for pyelonephritis
fever hasn’t gone down, sepsis, unable to take meds PO, urinary tract obstruction
pyelonephritis treatment?
Fluoroquinolones (only PO recommendations for outpatient)
-Cipro, Levo
Alternative Treatments:
-Bactrim PO, Augmentin PO, Cefpodoxime PO
symptomatic tx for pyelonephritis?
- Phenazopyridine
- Motrin, acetaminophen
- Anti-emetics -> Zofran
- IV fluids
acute cystitis in pregnant women and pyelonephritis in pregnant women are considered what?
complicated
signs and sx’s of acute cystitis in pregnant women?
usually asymptomatic (but still get treated)
what are you looking for in UA’s for UTI and pregnancy?
Looking for ketones b/c babies don’t like ketones
outpatient treatment for UTI and pregnancy?
- Macrobid
- Augmentin
- Cefpodoxime
- Fosfomycin
what meds should be avoided in the treatment of UTI and pregnancy?
FLUOROQUINOLONES!!!
UTI in pregnancy usually due to what?
anatomic changes during pregnancy
Pressure on bladder, increase in size of ureters due to smooth muscle relaxation, immunosuppression
traditionally treated UTI in pregnancy for how long?
24 hours
inpatient tx’s for UTI in pregnancy?
- IV beta-lactams
- Penicillin derivatives
- Cephalosporins (Cefazolin; Ceftriazone)
what is asymptomatic bacteriuria?
UTI found w/out sx’s
what is urine normally in asymptomatic bacteriuria?
sterile
prevalence of asymptomatic bacteriuria increases with?
age
-Elderly walking around with UTIs and don’t know it
asymptomatic bacteriuria most common in?
pregnant women
asymptomatic bacteriuria tx?
- Appropriate to treat and screen in pregnant women and patients undergoing urologic procedures
- Use of antibiotics same as cystitis
- Don’t treat the elderly, but will treat pregnant women
