S10C94 - UTI and Hematuria Flashcards
UTI encompasses:
- urethritis
- cystitis
- pyelonephritis
-UTI = bacteriuria + symptoms
RF for young healthy girls for UTI:
- sexual activity
- increased sexual activity in past month
- spermicide
- diaphragm use
- new sex partner in past 12mo
- age of first UTI
Uncomplicated UTI: defn
-UTI w/o structural/functional abnormalities without relevant comorbidities that place the pt at risk for more serious adverse outcome and not assoc with instrumentation
Complicated UTI: defn
-UTI with functional/anatomically abnormality or an infxn in the presence of comorbidities that place the pt as risk for more serious adverse outcome
- more likely to be infected with a resistant organism
- pts with pyelo may be uncomplicated but they generally get treated as if they were complicated
Risk factors for ocmplicated UTI
- male
- anatomic abnormality (catheter, stent, stone, neurogenic bladder, PCKD, instrumentation)
- recurrent UTI (>3/yr)
- older men
- nursing home
- neonate
- comorbidities (DM, SCD)
- pregnancy
- immunosuppressed
- neurologic dz
- atypical pathogen (non e coli infxns)
- resistant bug
Asymptomatic Bacteriuria
- presence of bacteria in urine on 2 successive urine cultures in a pt w/o symptoms
- pts: pregnant, catheters, nursing home
Relapse
-recurrence of UTI Sx w/in 1 month with same organism
Reinfection
-dvpt of symptoms 1-6mo after tx, usually by a different bug
> 3 UTI in one year
Investigate for:
- tumor
- stone
- diabetes
UTI pathogens
- most common: e coli
- other agents: KEEPS
- klebsiella, e coli, enterococcus, proteus/pseudomonas, staph saprophyticus
- group D strep, chlamydia, TB
-anaerobes don’t do well in urine
Sexual intercourse risk of UTI: pathophys
-due to milking action of urethra during intercourse, concentration of bacteria in the bladder increases by 10 fold
UTI symptoms
- dysuria, frequency, gross hematuria, fever and CVA tenderness markedly increase likelihood of UTI
- other sx: urgency, hesitancy, suprapubic discomfort
- suprapubic discomfort is more predictive than dysuria
-flank pain, CVA tender, renal tenderness, f/c, n/v, prostration are all common with acute pyelonephritis
Urine collection
-women: sit facing back of toilet, spread labia, clean from front to back with wipe, pass some urine then catch the rest
- men: clean urethral meatus, retract foreskin, obtain midstream urine
- for urethritis in men, first-stream urine should be collected
- bacteria double each hour in the urine at room temp
- cath specimens if need be, but 1-2% of pts develop a UTI after a single catheter insertion
Nitrite
- > 90% specificity for bacteria that convert nitrate to nitrite
eg. coliform bacteria (e. coli) - low sensitivity (50%)
-**enterococcus, pseudomonas, acinetobacter do not convert nitrate and are not detected by nitrite test
Leukocyte esterase reaction
- sensitivity of approx 77%
- specificity of approx 54%
Urine culture
-do for: complicated UTI, pregnant women, children, adult males, pts with relapse/reinfection
Imaging: u/s
-do for: male, elderly, diabetic, severely ill pts with pyelo
DDx: dysuria
- UTI
- vaginitis/cystitis
- urethritis
- trauma
- allergy
- rectol/colon d/o
- nephrolithiasis
- urethral stricture/obstruction
- fistulas
- FB
- urethral diverticulum
- cystocele
- chronic d/o
Acute cystitis and uncomplicated UTI: Tx
- e coli is pathogen most of the time
- usually can be treated with a 3d course
- septra DS 1 tab BID x3d is good choice but ++ resistance in some places
- cipro 250mg BID x3d
- levo 250mg OD
- macrobid XR 100mg BID x5-7d is good except doesn’t work for saprophyticus
- fosfomycin 3g PO once
Pyelo (uncomplicated): Tx
- cipro 500mg BID (7-14d)
- levo 500mg OD x14d
- septra DS 1 tab BID x14d
- amox clav BID x14d
