Urinary tract infection Flashcards
1
Q
UTI Epidemiology
A
Babies with UTI = boys
Elderly with UTI = Men and women equally affected
2
Q
Uncomplicated versus complicated UTI
A
Complicated:
- sepsis
- chronic pyelonephritis
- treatment failure
- pregnant
- diabetes
- stone
- structural GU abnormality
- spinal injury
- kids
- men?
Uncomplicated:
- healthy young women with pyelonephritis
- young men with cystitis
- healthy postmenopausal women with cystitis
3
Q
Laboratory approach:
Surrogate markers for UTI
A
- Dipstick leukocyte esterase test - sensitive test
- Microscopic hematuria
- Dipstick hemoglobin
- Dipstick nitrite (organism converts nitrite to nitrate); not as sensitive as LE test but is most specific
- Negatives in S. saprophyticus and enterococcus
- Bioluminescence - high NPV
- False negatives in enterococcus and candida
- Culture
4
Q
Define UTI
A
- Asymptomatic bacteruria
- Cystitis
- Pyelonephritis
- Urethritis
5
Q
Most direct and informative test for UTI
A
Culture - gold standard
- > 105 CFu/ml is the cut-off for mid-urine stream specimen (lower levels may be significant in complicated patients)
- Almost any level of bacteria taken from bladder directly is significant (>103 CFU/ml)
6
Q
Community UTI organisms
A
- E. coli #1 (80%)
- S. saprophyticus causes UTI in young sexually active women (about 15% of community UTI)
- other enterobacteriaceae: klebsiella, enterobacter
7
Q
Hospital acquired UTI
A
- BMT patients with hemorrhagic cystitis caused by adenovirus Type 11
- Fungal UTI (candida) in catheterized patients and those with recent abx
- Corynebacterium group 2
8
Q
Culture negative UTI
A
- Ureaplasma urealyticum
- Chlamydia
- Mycoplasma hominis
9
Q
Asymptomatic bacteruria
- diagnosis
- who requires treatment
A
Diagnosis
- Women: 2 voided urines with > 105 CFU/ml
- Men: 1 voided urine with > 105 CFU/ml
- Catheterized urine with > 102 CFU/ml
Treatment
- pregnant women
- patients undergoing GU instrumentation
