Urinary Tract Infection Flashcards
List THREE risk factors for UTIs
Female gender Previous UTI Sexually active female Increased age Genitourinary Tract Abnormalities
How can children with UTIs sometimes present?
Often vague symptoms: Decreased appetite Fever Irritability Vomiting
How can the elderly sometimes present with a UTI?
Vague symptoms: Delirium Functional decline Abdominal pain Falls Incontinence
List FIVE symptoms of cystitis
Dysuria Frequency of urination Urgency of urination Suprapubic tenderness Absent vaginal discharge/irritation
What may be a sign of cystitis?
Cloudy urine
45yo F with pain on urination, urinary frequency and suprapubic pain presents to you office. She does not have vaginal discharge or irritation. What would you do on a focused physical examination?
Vitals: Temp (normal = cystitis), BP and HR (hypotension and tachycardia = pyelonephritis)
Abdo exam - suprapubic tenderness
CVA tenderness = pyelonephritis
List FIVE common bacteria responsible for UTIs:
Klebsiella E. coli Enterococcus Proteus Staphylococcus saprophyticus Staphylococcus aureus
You suspect your patient has a UTI what test would you do to confirm your suspicions?
Urinalysis
Urine dipstick if urine is cloudy otherwise not useful. Urine dipstick also useless in catheterized patients.
List the indications for urine culture.
Complicated UTIs Female >65yo Suspected pyelonephritis Recurrent UTIs Failed Antibiotics or Persistent urinary symptoms Unclear urinalysis
42yo female was found to have bacteria in her urine on dipstick. She is otherwise asymptomatic. What do you do? What if this was a man?
Reassure her that there is no need to be concerned.
No urine culture needed as patient is asymptomatic.
Same management in men.
In a patient with a UTI who you suspect may have a complicating urolithiasis, how would you confirm this suspicion?
Abdominal ultrasonography or Computed Tomography Scan of Abdomen
What is the definition of recurrent UTI?
2 or more UTIs in 6 months OR >2 positive cultures in 1yr
What is the definition for a UTI reinfection?
Infection with new organism >2wks after initial infection
What is the definition of a UTI relapse?
Repeat/continued infection with same organism within 2wks of completing ABx for UTI
How would you treat acute cystitis in pregnant women?
Amoxicillin 500mg po tid x 7d
Macrobid 100mg po bid x 5d
Fosfomycin 3g in 1/2 cup water po x 1
How would you treat uncomplicated UTI in a female?
Septra 2tabs po bid x 3 days
Trimethoprim 200mg po daily x 3 days
Macrobid 100mg po bid x 3 days
How would you treat an uncomplicated UTI in children?
TMP/SMX (dose TMP 10mg/kg/day divide by 2) po bid x 7-14d
Nitrofurantoin (5mg/kg/day divided by 4) qid x 7-14d
How would you treat a pyelonephritis OR complicated UTI?
Septra 2tabs po bid x 7-14d
Trimethoprim 200mg po daily x 7-14d
Macrobid 200mg po bid x 7-14d
Ciprofloxacin 500mg po bid x 7-14d
How would you treat cystitis that recurs in female less than 1 month after treatment?
Septra 2tabs po bid x 7-14d
Trimethoprim 200mg po daily x 7-14d
Macrobid 100mg po bid x 7-14d
How do you treat recurrent infections of cystitis in females?
Septra 1tab po 3/wk or postcoital x 6mo
Trimethoprim 100mg po qhs or postcoital x 6mo
Macrobid 100mg po qhs or postcoital 6mo
Reassess for discontinue after 6 months
How do you know if a patient has a complicated versus an uncomplicated UTI
Uncomplicated = otherwise healthy, premenopausal woman, not preggers, normal GU anatomy
Complicated = men, preggers
- Hx of GU instrumentation (catheters, ureteric stents, procedures, transplants)
- Metabolic abnormalities (renal disease)
- Underlying disease (bad DM control, polycystic kidney dz, immunosuppression)
- GU tract abnormalities (BPH, strictures, renal stones, renal cysts, vesicoureteral reflux, posterior urethral valves)
Describe a patient who would be considered to have an uncomplicated UTI
Otherwise healthy, pre-menopausal female, not preggers with no GU abnormalities
What factors make a UTI become complicated?
Male gender
Preggers
Metabolic abnormalities (renal failure, DM)
Underlying Dz (poor DM control, Polycystic kidney Dz, immunosuppression)
Hx of Urinary Tract instrumentation (catheters, stents, procedures, transplants)
List the indications for Renal-bladder U/S and VCUG
- 1st UTI in male
- 1st UTI in female less 3y
- complicated pyelonephritis
- recurrent UTI
- FHx renal abnormalities