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Urology > Urinary Tract Infection > Flashcards

Urinary Tract Infection Flashcards

1
Q

Describe the bacterial etiology of UTI.

A

E coli = most common d/t NOT:
- wiping front to back
- using condoms
- washing after sex

S saprophyticus:
- women with STI’s

Proteus = suspect kidney stone

Klebsiella:
- catheter
- polymicrobial

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2
Q

Describe the non-bacterial pathogenesis/etiology of UTI.

A
  • Intercourse
  • Inadequate hydration
  • Voiding infrequently (< q 2-3 hours)
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3
Q

What are the guidelines for screening/treating asymptomatic bacteriuria?

A

Screen & Treat:
- ALL pregnant women with antibiotics x 4 - 7 days
(to prevent pre-term labor)

Do NOT treat:
- children
- older adults
- diabetics
- transplant recipients (especially kidney)
- spinal cord injury
- indwelling catheter

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4
Q

How is uncomplicated UTI classified?

A

Uncomplicated UTI:

  • Cystitis/bladder infection/UTI
  • Low patient risk
  • NO systemic symptoms
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5
Q

How is complicated UTI classified?

A

Complicated UTI:

  • Kidney involvement (lower or upper)
  • High risk patients:
    • older age
    • pregnancy
    • pediatric patients
  • Systemic symptoms:
    • fever
    • malaise, etc.
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6
Q

What are the key signs/symptoms of uncomplicated UTI?

A

Triad of symptoms:
- dysuria
- urgency
- frequency

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7
Q

What are signs/symptoms of uncomplicated UTI other than the key triad?

A
  • Incomplete emptying sensation
  • Suprapubic pain
  • Back pain
  • Gross hematuria (may also be micro hematuria)
  • Foul-smelling urine (if proteus bacteria, suspect stones)
  • Scant voiding
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8
Q

If a UTI is suspected, what diagnostic studies should be ordered?

A
  • Urinalysis
  • Urine culture ONLY if:
    • recurrent infection (clears and returns)
    • refractory infection (never clears)
    • high risk patients:
      - children
      - men
      - pregnant women
      - older adults
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9
Q

What results indicate a positive urine culture?

A
  • Midstream > 100,000 organisms
  • Catheter > 1,000 organisms
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10
Q

What urinalysis results indicate infection?

A

Nitrites = Gram negative bacterial infection

WBC’s = infection

WBC casts = pyelonephritis

Leukocyte esterase: usually = infection

2/3 of the following = infection:
- blood
- nitrites
- leukocytes

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11
Q

Discuss the role of nitrates and nitrites in urinalysis for UTI.

A

Nitrates:
- normal in urine
- converted to nitrites by gram negative bacteria

Nitrites = gram negative infection
- sensitivity: only 50% d/t only indicates gram negative infection
- specificity: high

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12
Q

Discuss the role of WBC’s/pyuria in urinalysis for UTI.

A

WBC’s = infection
- most reliable indicator of infection (95% sensitivity)

*WBC casts = pyelonephritis

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13
Q

Discuss the role of leukocyte esterase in urinalysis for UTI.

A

Leukocyte esterase:
- enzyme produced by WBC’s
- specificity = 60% - 90%
- usually indicates UTI

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14
Q

What is the first-line antibiotic treatment for uncomplicated UTI?

A

Nitrofurantoin/Macrobid:
- avoid if pyelonephritis suspected
- avoid in 1st trimester of pregnancy

Duration: 3 - 6 days

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15
Q

What are appropriate antibiotics for uncomplicated UTI?

A
  • Nitrofurantoin = FIRST LINE!
  • Bactrim
  • Cephalosporins
  • Ciprofloxacin/Levofloxacin

Avoid any antibiotic taken in the past 3 months!

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16
Q

What is important to remember about Bactrim in conjunction with UTI?

A

Bactrim:
- mostly inappropriate d/t E. coli resistance > 20% in most US states
- do NOT use for patients < 2 months old

17
Q

Which groups of patients should receive cephalosporins for uncomplicated UTI and why?

A

Reserve for use with:
- children
- pregnant women

Why?
- Due to high rates of resistance with E. coli.

18
Q

Discuss the use of ciprofloxacin/levofloxacin with uncomplicated UTI.

A
  • Low rates of resistance with E. coli but NOT FIRST LINE!
  • Cautioned use with QT prolongation
  • Not for use with:
    - <18 years old
    - pregnancy
19
Q

What medications (other than antibiotics) should be considered for patients with uncomplicated UTI and why?

A

Antispasmotics: Why?
- Phenazopyridine (pyridium) - for dysuria
- Flavoxate (urispas) - has antiseptic properties
- ** Turns urine orange

Local estrogen - Who?/Why?
- if postmenopausal
- reduces UTI risk d/t E2 receptors in urethra

20
Q

What instructions (non-pharmaceutical-related) should be given to patients with uncomplicated UTI?

A
  • Treat UTI promptly
  • Hydrate with 8 glasses (8 oz each) of water daily
  • Avoid bladder irritants:
    • caffeine
    • alcohol
    • carbonated drinks
    • fruit juice
  • Sexual intercourse:
    • avoid during treatment
    • void afterward
    • use lubrication
  • Follow up within 1 month if blood is present on diagnosis
21
Q

List common features of complicated UTI.

A
  • Can be lower or upper UTI
  • Symptomatic or asymptomatic
  • Asymptomatic bacteriuria in pregnancy
  • Comorbid conditions (DM, immunocompromised, etc.)
  • Structural, functional, metabolic, or catheter
  • Multi-drug resistance
  • Greater risk for sepsis, bacteremia, or death
  • Special groups:
    - older adults
    - pregnancy
    - men
    - children
22
Q

What are common signs and symptoms of complicated UTI?

A

S/S of uncomplicated UTI, especially:
- dysuria
- urgency
- frequency

Systemic S/S:
- fever
- chills
- rigors
- marked fatigue or malaise

23
Q

What signs and symptoms might be expected in older adults with complicated UTI?

A
  • Fever
  • Fatigue
  • Falls
  • Mental status changes
  • Hematuria
  • Anorexia
  • Nausea/vomiting
  • Sepsis
  • New or worsening urinary incontinence
24
Q

Describe treatment duration for complicated UTI.

A

7 - 14 days for:
- children
- pregnant women
- diabetic patients
- older adults

10 - 14 days for:
- men* d/t complex anatomy
(rare < 50 years old)

*Note: get culture for urine and STD

25
Q

What assessment findings and diagnostic tests might indicate upper UTI/complicated UTI vs lower UTI/uncomplicated UTI?

A

Assessment:
- CVA tenderness

U/A:
- WBC casts indicate pyelonephritis
- Blood: if + (or if patient very ill) => REFER (note: get culture with sensitivity before Rx)

CBC:
- Leukocytosis

Sed Rate (ESR)/CRP:
- Positive indicates inflammation => Upper UTI

26
Q

Discuss the significance of the following casts when found in urinalysis:

Hyaline
Crystals
RBC
WBC
Epithelial

A

Hyaline:
- most common
- Causes:
- low urine low
- dehydration
- vigorous exercise

Crystals: No clinical significance

RBC:
- ALWAYS pathological => REFER!!!
- Causes:
- possible glomerulonephritis
- lupus
- urinary tract injury

WBC:
- REFER!!!
- Causes:
- inflammation
- infection
- pyelonephritis (not UTI)

Epithelial:
- Causes:
- acute nephrosis
- hepatitis

Urology (8 decks)

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