Urinary Tract Infection Flashcards
infection that recurs with a different organism
reinfection
infection where organism persists in the urinary tract despite antimicrobial therapy, same organism
relapse
interleukin involved in UTI
IL8 (pyruria) IL6 (severity of infection, fever)
symptomatic men, cut of in urine culture
10^3
in and out catheter
10^2
more active in acidic urine
penicillin, tetracycline, nitrofurantoin
more active in alkakine urine
aminoglycosides, fluoroquinolones, erythromycin
antibiotic penetrate poorly in the prostate gland because of
no active antibx transport mechanism
antibx that penetrate in the prostate well and remain active
fluoroquinolones and macrolides
cause of cystitis
e. coli
in cystitits, infection occurs via the
ascending route
second most frequent isolate and virtually unique to acute cystitis
S. saprophyticus
major risk factor for recurrent cystitis in women of any age
infection at a younger age
stongest association of recurrent acute cystitis in postmenopausal women
history of prior UTI
urine culture in cystitis should be obtained when
- clinical presentation not characteristic
- failure to respond to appropriate empiracal antimicrobial therapy
- early symptomatic recurrence after therapy
mainstay of empirical treatment of acute cystitis
TMP/SMX (3 days)
recommended for women who experience more than 2 episodes in 6 months of UTI
low dose prophylactic antimicrobial therapy
only feasible behavioral intervention for recurrent infection
avoid spermicide use
strongest association to pyelonephritis in premenopausal women
recent sexual intercourse
independent risk factor for pyelonephritis
diabetes
imaging in pyelonephritis is required for
severe symptoms or treatment failure or early post treatment recurrence
initial imaging modality for pyelonephritis
ultrasonography
optimal diagnostic imaging for acute pyelonephritis
contrast enhanced CT
indications for hospitalization
pregnancy, unstable, compliance with oral, medical illness
preferred empirical regimen for pregnant women
ceftriaxone
clinical response after initiation of therapy
48-72 hours
recommended empirical antimicrobial
ciprofloxacin or levofloxacin
duration of treatment pyelonephritis
10-14 days
alternate microbial therapy for pregnant women when cephalosporin cannot be used
gentamicin
risk factors of a poor outcome for pyelonephritis
hospitalization, isolation of a resistant organism, DM, renal stones
major determinant of infection
host impairment
encrusted cystitis or pyelonephritis caused by
corynebacterium urealyticum
urease producing bacterium causing cystitis or pyelonephritis with urolithiasis
u. urealyticum
symptomatic UTI + repeatedly negative urine culture
fastidious organism
alkaline pH + pyuria + negative urine culture
urease producing organism
most frequent isolate in men older than 65
cons
E coli
enterococcus
screening and tx of asymptomatic bacteriuria
pregnant women and traumatic genitourinary tract procedure
when to screen pregnant for asymptomatic bacteriuria
end of 1st trimester
recommended regimen for asymptomatic bacteriuria in pregnant
5 or 7 day course of nitrofurantoid, 7 day course of amox, co-amox or cephalosporin
Urine CS should be done after treatment
monthly
urologic emergency with systemic manifestations
acute bacterial prostatitis
management of acute bacterial prostatitis
- drainage of a urethral or suprapubic catheter
- antibx
first line therapy for acute bacterial prostatitis
- B lactam + aminoglycoside
- FQ 6 weeks
if no clinical response (acute prostatitis)
CT or MRI and transrectal UTZ guided aspiration
diagnosis for chronic bacterial prostatitis
paired culture of midstream + post prostatic massage urine specimens
most common isolates for chronic bacterial prostatitis
enterbacteriacease and p. aeruginosa
first line for susceptible organisms in chronic bacterial prostatitis
ciprofloxacin and levofloxacin
second line drugs for chronic bacterial prostatitis and preferred for gram + infections
doxycycline and macrolides
chronic pelvic pain syndrome + negative culture
4 week trial of antimicrobial
prophylaxis for the 1st 6 months after transplant for UTI
TMP/SMX