SU2M - Infections of the GU tract Flashcards
9 Risk factors of UTIs?
- Female gender
- Sexual intercourse –> esp in females, or with use of spermacides
- Indwelling urinary catheters
- Pregnancy
- Personal Hx of recurrent UTIs
- Diabetes –> esp. upper UTIs
- Spinal cord injury
- Immunocompromised state
- Structural or functional abnormality that impedes urinary flow –> ex. incomplete voiding, neurogenic bladder, BPH, vesicourethral reflux, calculi
9 Most common organisms that cause UTIs?
- E.coli –> MOST common (80%)
- Staph saprophyticus
- Enterococcus
- Klebsiella
- Proteus spp.
- Pseudomonas
- Enterobacter
- Yeast –> esp Candida
3 Risk factors for UTIs in men?
- Uncircumcised
- Anal intercourse
- vaginal intercourse with a female colonized with uropathogens
6 Ssx of UTIs?
- Dysuria –> usually burning with urination
- Frequency
- Urgency
- Suprapubic tenderness
- Gross Hematuria
- Fever –> ONLY seen in upper UTIs
When should a urine culture be obtained with a UTI (5)?
- Patient > or 65 yrs old
- DM pt
- Recurrent UTIs
- Presence of sx for 7+ days
- Use of diaphragm
Asymptomatic bacteriuria: dx? tx?
- dx: 2 successive + cultures (> or = to 10^5 CFU/mL)
- tx: ONLY tx in pregnancy or before urologic surgery
Most important finding on urinary analysis?
- WBCs
- > or = to 10 WBCs = abnormal!
Dipstick urinalysis?
- Positive urine leukocyte esterase test = pyuria
- Positive nitrite test = enterobacteriaceae ONLY
* *combining the 2 tests will increase sensitivity and specificity
Presence of epithelial cells in Urinalysis?
- indicate vulvar or urethral contamination
- if contamination is suspected, perform a straight catheterization of the bladder
3 risk factors for upper UTI?
- Pregnancy
- DM
- Vesicourethral reflux
Recurrent infections: new or relapse? risk factors? consequences?
- usually from a new organism, but can sometimes be a relapse if the original infection was not treated properly
- risk factors: impaired host defense, pregnancy, vesicourethral reflux, sexual intercourse in women
- consequences are usually not significant, unless the pt is at risk for upper UTIs
4 most common antibiotics given for an uncomplicated UTI?
- Oral TMP/SMX (bactrim) for 3 days
- Nitrofurantoin for 3-5 days –> DONT give if early pylonephritis is suspected
- Fosfomycin, singe dose –> DONT give if early pylonephritis is suspected
- Floroquinolones for 3 days –> alternative to above antibiotics
Phenazopyridine: use?
- urinary analgesic
- can be given for 1-3 days for dysuria
3 Possible tx for UTI in pregnancy? What drug should be avoided? Why?
- Ampicillin
- Amoxicillin
- Oral Cephalosporins for 7-10 days
* *Avoid fluroquinolones –> can cause fetal arthropathy
Tx of UTIs in men?
- treat as an uncomplicated UTI in a female, but give tx for 7 days instead
- do a work up if there are complications or recurrence
Tx for relapse of UTI within 2 weeks of the end of initial tx?
- continue tx for 2 more weeks
- then get urine culture
When should prophylaxis be given for recurrent UTIs? Tx?
- when the pt has more than 2 UTIs per year
- prophylaxis options:
1. single dose of TMP/SMX after intercourse
2. single dose of TMP/SMX at the first sign of UTI
3. low-dose prophylactic antibiotics for 6 mnths
8 Ssx of pyelonephritis?
- Fever/chills
- Flank pain
- Sx of cystitis –> may or may not be present
- GI sx: nausea, vomiting, & diarrhea –> sometimes present
- fever w/ tachy
- appear more ill than a pt with cystitis
- costovertebral angle tenderness –> unilateral or bilateral
- Abdominal tenderness on examination
Pyelonephritis: definition?
-infection of the upper urinary tract
Cystitis: definition?
-bladder infection
3 Things to look for in urinalysis of pylenophritis?
- Pyuria
- Bacteriuria
- LEUKOCYTE CASTS
3 Antibiotics for tx of pylenephritis? What to do if tx fails?
- TMP/SMX for 10-14 days (for gram-neg rods)
- Fluroquinolones for 10-14 days (for gram-neg rods)
- Amoxicillin (for gram-pos cocci –> enterococci or staph sapro)
- single dose of ceftriaxone or gentamycin is often given initially before starting oral tx
- repeate urine culture in 2-4 days, if sx are not resolving after 48hrs, then switch antibiotic according to the culture
- failure to respond to tx = functional or structural abnormality –> workup needed!
Which pts should be hospitalized for tx of pyleonephritis?
- very ill
- elderly
- pregnant
- unable to take oral meds
- significant co-morbidities
- suspected urosepsis
Tx for hospitalized pts with pyelonephritis?
- tx with antibiotics:
1. ampicillin plus gentamicin
2. ciprofloxcin - obtain blood cultures:
1. if negative, tx with IV antibiotics until afebrile for 24 hrs, then give enough oral antibiotics to complete a 14-21 day course
2. if positive, tx IV antibiotics for 2-3 weeks
Tx for relapse of pylenophritis?
- If its the same organism, tx for 6 weeks
2. If it is from a new organism, tx with appropriate antibiotic for 2 weeks
Acute bacterial prostatitis: who is it more common in?
- younger men
- less common that chronic bacterial prostatitis
Acute bacterial prostatitis: Pathophysiology?
- Ascending infection from urethra
- Reflux of infected urine
- After urinary catheterization
- Spread from rectum –> direct or lymphatic
- Hematogenous spread (rare)
* *these all can also cause chronic prostatitis!
Chronic bacterial prostatitis: who is it commonly seen in? pathophysiology?
- more common than acute
- most commonly sen in men ages 40-70
- same routes of infection as acute prostatitis, can also develop from acute prostatitis
6 Ssx of acute prostatitis?
- Fever/chills
- Dysuria
- Frequency
- Urgency
- Pain:
- low back
- perineal - urinary retention
Ssx of Chronic bacterial prostatitis?
- patients are often asymptomatic, they do not appear ill
- fever is uncommon
1. Recurrent UTIs
2. Irritative voiding sx
3. Obstructive urinary sx
4. Pain: - dull
- poorly localized in the lower back, perineal, scrotal, or suprapubic region
3 Tests for dx of acute bacterial prostatitis?
- DRE = boggy & very tender –> be careful not to cause bacteremia, may want to skip DRE if dx is obvious!
- Urinalysis = sheets of WBCs
- Urine cultures = almost always positive in acute
* *obtain a CBC and blood cultures in a pt that appears toxic or if sepsis is suspected!
Dx of Chronic prostatitis?
- DRE –> prostate is usually large and nontender
- Urine cultures –> may be positive or negative (nonbacterial prostatitis)
* *obtain a CBC and blood culture in a pt that appears toxic or if sepsis is suspected
Tx of acute prostatitis?
- if severe and the pt appears toxic, hospitalize the pt and start IV antibiotics
- if mild, tx outpatient with antibiotics for 4-6 wks:
1. TMP/SMX
2. Fluroquinolones + doxy
Tx of Chronic bacterial prostatitis?
- tx with fluorouinolones, prolonged course might be needed
- hard to tx
- recurrences are common!
