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PHARMACY PRACTICE II > URIANRY TRACT INFECTIONS > Flashcards

URIANRY TRACT INFECTIONS Flashcards

1
Q

UTI can progess to the following infections

A

Pyelonephritis
Urosepsis

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2
Q

Why do neonates present with nonspecific symtoms in UTI

A

UTIs in neonates are due to hematogenous rather than ascending infection

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3
Q

Where does UTI generally begin from after the neonatal period

A

The bladder with ascending disease to the kidneys

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3
Q

Bacterial invasion of the bladder with overt UTI symptoms is more likely to occur if……….

A

Urinary stasis or low flow conditions exist

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4
Q

Effect of circumcision on UTI

A

Uncircumcised males> Circumcised males

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4
Q

UTI prevalence in different sexes

A

Neonates: males>females
Above neonatal period: females>males

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5
Q

Risk factors for UTI

A

Bacterial virulence
Host factors

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6
Q

factors in bacteria that increases their virulence in UTIs

A

Antigen K
Presence of fimbriae

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7
Q

Host factors that predispose to UTI

A

Anatomical
Functional
Immunologic

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7
Q

Causes of UT obstruction

A

Phimosis
Meatal stenosis
Posterior urethral valve disorder
Diverticuli
Ureteric stricture or kink
Claculi

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8
Q

Anatomical host risk factors of UTI

A

Vesicoureteral reflux
Abnormal insertion of ureters in the bladder
UT obstruction
Indwelling catheter

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9
Q

Meatal stenosis

A

Narrowing of the opening at the end of the penis (the external urethral opening or meatus)

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9
Q

Phimosis

A

A condition in which tight foreskin cannot be pulled back over the head of the penis

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10
Q

Posteriori urethral valve

A

Obstructive valves that develop in the urethra close to the bladder, obstructing urine outflow

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11
Q

Symptoms of UTI in neonates

A

Jaundice
Hypothermia or Fever
Failure to thrive
Poor feeding
Vomiting

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11
Q

Functional host risk factors of UTI

A

Neurogenic bladder in spina bifida
Inappropriate detrusor muscle contractions

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12
Q

Symptoms of UTI in infants

A

Poor feeding
Fever
Vomiting
Diarrhoea
Strong-smelling urine

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12
Q

Symptoms of UTI in preschoolers

A

Vomiting
Diarrhoea
Abdominal pain
Fever
Strong-smelling urine
Enuresis
Dysuria
Urgency
Frequency

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13
Q

Difference between UTI symptoms in preschoolers and school age children

A

Preschoolers - diarrhoea
School age children- flank pain

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13
Q

Symptoms of UTI in school age children

A

Fever
Vomiting
Abdominal pain
Strong-smelling urine
Dysuria
Frequency
Urgency
Flank pain
New enuresis

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14
Q

Hypertension in UTI raises suspicion of…..

A

Hydronephrosis
Renal parenchyma disease

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15
Q

Most common cause of UTI

A

E. coli

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16
Q

Causative agents of UTI

A

(FASKEEP)
Fungi in immucompromised patients
Adenovirus
S. aureus
Klebsiella spp
Enterocossus spp
E. coli
Proteus spp

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16
Q

Differentials of UTI

A

Sepsis
Falciparum malaria
GIT disorders
Renal calculi
Urethritis
Vaginitis
Vulvovaginitis

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17
Q

Physical examination in UTI

A

Costovertebral angle tenderness
Abdominal tenderness or mass
Palpable bladder
Examine external genitalia
Dribbling, poor stream or straining to void

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18
Q

Urinalysis diagnosis of UTI

A

Urine positive for nitrite, leukocyte esterase or blood

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18
Q

Which investigations can urine bag specimen be used for

A

Specific gravity
Chemical parameters
Not for culture

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19
Q

Microscopic examination of urine in UTI shows:

A

Presence of WBC(>5 per high-power field)
RBC
Bacteria
Casts
Epithelial cells

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19
Q

When is bag specimen used for UTI investigations in neonates and infants

A

If the urine bag is removed immediately after urine is collected

20
Q

Urine sample collection in UTI

A

Midstream in adults

Bladder puncture in neonates and infants

21
Q

Classic criteria for UTI

A

A clean-catch urine sample with more than 100,000 CFU of a single organism

If the specific gravity of the urine was low, 60,000-80,000 CFU may be significant.

22
Q

When is lower colony counts significant

A

If present on a repeat culture

23
Q

Why is urine collected in bags not suitable for culture

A

Due to high incidence of contamination

24
Q

How to obtain better results from bag specimen

A
  1. Clean and dry perieum before placing bag
  2. Remove collected urine as soon as patient voids
25
Q

Which level of CFU from bladder catheterization is considered significant for UTI

A

10,000 pure CFU/ml

26
Q

Which level of CFU from suprapubic aspiration is considered significant for UTI

A

> 1000 CFU/ml

27
Q

Increased BUN in a child older than 2 months raises suspicion for

A

Hydronephrosis
Renal parenchyma disease

28
Q

Imaging studies in UTI

A
  1. Renal ultrasound
  2. Voiding cystourethrogram (VCUG)
29
Q

Role of renal ultrasound in UTI

A

Depicts Kidney size and shape

30
Q

limits of renal ultrasound

A

Poorly depicts ureters
No information on function

31
Q

Role of VCUG

A
  1. Depicts Urethral and bladder antomy
  2. Detects vesicoureteral reflux (VUR)
32
Q

Standard criterion for urine sample collection in UTI investigations

A

Suprapubic tap

33
Q

Most invasive diagnostic procedure in UTI invetsigations

A

Suprapubic tap

34
Q

Diagnostic procedure for patients who cannot provide a midstream clean-catch urine sample

A

Catheterization of the bladder
Suprapubic bladder aspiration

35
Q

When is a urologist consulted at patient presentation

A

Evidence of urinary tract obstruction

36
Q

When is short course therapy used

A

Adolescent females with evidence of cystitis

36
Q

Recommended duration of antibiotic treatment in UTI

A

10 days

36
Q

Why is short course therapy not used on children

A

It is more difficult to differentiate between cystitis and pyelonephritis`

37
Q

Which route of antibiotics is used for febrile UTI in young infants and children according to recent evidence and why

A

Oral antibiotics
Because Short term(fever) and long term (pyelonephritis) outcomes are comparable to parenteral therapy

37
Q

Which UTI patients require aggressive management in ER

A

Septic or toxemic patients

37
Q

Route of antibiotics for cystitis and pyelonephritis

A

Cystitis- oral
Pyelonephritis- parenteral

38
Q

Cystitis vs pyelonephritis

A

Cystitis: infection of bladder and urethra
Pyelonephritis: Infection of kidney

39
Q

Antibiotics used in UTI

A

5C-GAN
Cefotaxime
Cephalexin
Cefixime
Ciprofloxacin
Co-trimoxazole
Gentamicin
Amoxicillin
Nalidixic acid

40
Q

Amoxicillin dose

A

Paediatrics: IV/IM 100-200mg/kg/day divided q6hrs

41
Q

Amoxicillin is usually combined with……

A

Gentamicin or Cefotaxime

42
Q

Gentamicin dose

A

<5yrs: 2.5mg/kg/dose IV/IM q8hrs

> 5yrs: 1.5-2.5mg/kg/dose IV/IM q8hrs

43
Q

Which antibiotic used as initial therapy for paediatrics with acute pyelonephritis?

A

Cefotaxime

43
Q

Which antibiotic is used for neonates or jaundiced patients?

A

Cefotaxime

44
Q

Cefotaxime dose

A

Paediatrics: 100-200 mg/kg/day in divided doses q6-8hrs

45
Q

Spectrum of Co-trimoxazole

A

Common UTI pathogens ecxept P. aeruginosa

46
Q

Dose for co-trimoxazole

A

> 2months: 5-10 mg/kg/day PO divided q12hours, based on TMP content

46
Q

Dose for Cephalexin

A

Paediatric: 25-50mg/kg/dose PO q6h, max-3g/day

46
Q

Dose for cefixime

A

Paediatric: 8mg/kg/dose PO qd: max:400mg/day

47
Q

Oral antibiotics
used in UTI in paediatrics

A

Cephalexin
Cefixime
Co-trimoxazole

48
Q

Parenteral antibiotics used in UTI in paediatrics

A

Ampicillin
Cefotaxime
Gentamicin

49
Q

Contraindications to nalidixic acid

A

G6PD, causes hemolysis

50
Q

Why is nalidixic acid used in UTI

A

it has minimal distribution in
tissues and is excreted mainly through the kidneys and
reach high concentration in urine

51
Q

When is ciprofolxacin used

A

Second line or for recurrent UTI

52
Q

Most common complication of UTI

A

Dehydration

53
Q

Long term complications of UTI

A

Renal parenchyma scarring
Hypertension
Decreased renal function
Renal failure

PHARMACY PRACTICE II (17 decks)

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