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Host And Defense - Exam 3 > Quiz 7 - Spivak - UTIs > Flashcards

Quiz 7 - Spivak - UTIs Flashcards

1
Q

What is bacteriuria?

A

Bacteria in urine

-Not necessarily an infection

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2
Q

What is a UTI?

A

Bacterial infection of lower or upper urinary tract

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3
Q

What is acute cystitis?

A

Bacterial infection of the BLADDER

-Lower UTI

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4
Q

What is acute pyelonephritis?

A

Bacterial infection of upper urinary tract

-Ureters, renal pelvis, kidney parenchyma

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5
Q

Uncomplicated UTI criteria. 3 types of people.

A

Not pregnant

Normal urinary anatomy

No co-morbidities

*Pts w/ uncomplicated UTI should meet ALL of these criteria

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6
Q

Tell me those that will have complicated UTI.

A

Pregnant

Abnormal urological anatomy or fx

Diabetes mellitus

Immune compromise

Catheter

Male

Pt should be dx with this if they meet ANY of these criteria

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7
Q

T/F - Distinction b/t complicated and uncomplicated UTIs is becoming less important as shorter durations of therapy show to be effective.

A

TRUE

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8
Q

What is asymptomatic bacteriuria?

A

Positive urine culture w/o signs or symptoms

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9
Q

What is uncomplicated UTI?

A

UTI in a structurally and neurologically normal urinary tract

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10
Q

What is complicated UTI?

A

UTI in presence of factors that predispose to persistent or relapsing infection

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11
Q

T/F - UTI is one of the most common bacterial infections seen in outpatient setting.

A

TRUE

*By age 32, 50% of women have had at least one UTI

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12
Q

T/F - Cystitis (lower UTI) is more common than pyelonephritis.

A

TRUE

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13
Q

T/F - Urinary tract is normally sterile in young, healthy pts.

A

TRUE

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14
Q

___% of bacteria that cause UTIs are G- colonizers of the GI tract.

A

85%

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15
Q

What is the most predominant pathogen in UTIs (75-95%)?

A

E COLI

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16
Q

What other pathogens are present in UTIs?

A

Proteus mirabilis

Klebsiella pneumoniae

Staphylococcus saprophyticus

17
Q

What is the general pathogenesis of UTIs?

A

Ascend thru urethra to bladder

  • Urethra is shorter in women than men
  • Prostatic fluid has anti-bacterial properties

Continue to ascend to ureters/kidney

18
Q

What are some E. coli virulence factors?

A

Pili

Flagella

Adhesins

Siderophores

Toxins

Polysaccharide coating (G-)

19
Q

What are 4 symptoms suggestive of cystitis?

A

Pain or burning w/ urination

Increased frequency of urination

Increased urgency of urination

Suprapubic pain

20
Q

What are 4 symptoms of pyelonephritis?

A

Fever and/or chills

Flank or costo-vertebral pain

Nausea/vomiting

+/- symptoms of cystitis

21
Q

Are pyuria, positive urinalysis, cloudy, or foul-smelling urine symptoms of UTI?

A

NO

22
Q

What is the GOLD STANDARD for the dx of UTI?

A

Symptoms AND

Urine culture of >10^5 cfu of uropathogenic bacteria/mL

23
Q

What is a positive urine culture W/O SYMPTOMS?

A

Asymptomatic bacteria

24
Q

T/F - UA/microscopy utility for UTI dx is to rule OUT UTI based on absence of pyuria.

A

TRUE

25
Q

T/F - Obtaining a UA is NOT necessary for UTI dx when specific UTI signs or symptoms are clearly present or absent.

A

TRUE

26
Q

T/F - A UTI dx can not be based on UA or urine culture alone.

A

TRUE

27
Q

T/F - Pyuria is common in pts with asymptomatic bacteriuria.

A

TRUE

28
Q

Can we dx a UTI based on culture values alone?

A

NO

Need symptoms as well

29
Q

What are 3 medications used to manage uncomplicated cystitis?

A

Nitrofurantoin

Trimethoprim-sulfamethoxazole (TMP/SMX)

Fosfomycin

Cystitis generally resolves w/o antibiotics, they are used to provide symptom relief

30
Q

What are 3 drugs used to manage uncomplicated pyelonephritis?

A

Fluoroquinolones

TMP/SMX

Beta-lactams

If the pt is unstable (severe symptoms), then they should be admitted to the hospital for IV antibiotics

31
Q

E. coli’s resistance to amoxicillin is now >__% worldwide.

A

20%

32
Q

Fluoroquinolone resistance is ___-___% and rising quickly.

A

30-35%

33
Q

When should antibiotics be considered for asymptomatic bacteriuria? 4 types of pts.

A

Pregnant

Pre-urology procedure

Renal transplant (Maybe?)

Neutropenic

34
Q

What are consequences of over-testing and over-tx?

A

Developing resistant organisms

Missing the real diagnosis

35
Q

What is a CAUTI?

A

Catheter-Associated UTI

36
Q

What are some CAUTI symptoms?

A

Lack typical UTI symptoms

New fever w/ no other source

Costovertebral angle tenderness, flank pain, pelvic discomfort

37
Q

How to dx a CAUTI?

A
  • Presence of inflammation on UA (pyuria) does NOT correlate w/ infection
  • Absence of pyuria rules OUT CAUTI
  • Urine culture with >/= 10^5 cfu
38
Q

What is pyuria?

A

WBCs in the urine

39
Q

Tx of CAUTI?

A

Remove catheter whenever possible

Replace catheters that have been in >/= 2 wks if still indicated

Ax duration

  • 7 days if prompt response
  • 3 days if catheter removed in female pt w/ no evidence of associate pyelonephritis

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