Urinary Tract Infection (Exam 4) Flashcards by Lucas Keck

Men or women are at greater risk of UTI

Women - shorter urethra

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how do UTI’s often happen to women

Bacteria colonizes the vaginal introitus (opening).

Bacteria ascends the urethra to bladder

Not urinating after sexual intercourse

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Kids often get UTI’s by what mechanisim

-Uncircumcised pts
-catheter placement
-reflux / anatomical abnormalities
-Bladder not working correctly or constipation
(BBD- bladder and bowel dysfunction)

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Mechanism of Pyelonephritis

Develops when pathogens ascend up the ureters to the kidneys

can also occur by seeding- the kidneys from bacteremia or bacteria in lymphatics

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Uncomplicated Cystitis

Confined to the bladder in a non-pregnant woman

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Complicated Cystitis

Fever
chills
rigors
flank pain
CVA tenderness
Infections past the bladder
any other underlying condition

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Epidemiology of Cystitis

most common in women
recent sexual intercourse
History of UTI's 
Urinary tract abnormalities 
Catheter
Obesity

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Etiology of Cystitis

Most commonly - E. Coli
other bacterias are common
increased resistance common
contaminated urine - can show lactobacilli, enterococci, Group B strep, Coagulase neg staph.
How do we tell if contaminated- epithelial cells

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Clinical Presentation and Pathophysiology for cystitis in children under 2

fever, vomiting, diarrhea, irritable, not growing or eating well.

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Clinical Presentation and Pathophysiology for cystitis in children over 2

Dysuria, frequency, pain in lower abdomen or back, fever

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Clinical presentation and pathophysiology for cystitis in Adults

Dysuria, frequency, urgency, suprapubic pain, hematuria possible, possible fever, they can be asymptomatic

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In older individuals with little or varied or no symptoms but what do we worry about with geriatrics

Delirium

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Always always always check for what in women with abdominal pain

Blood HCG for pregnancy

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DDX for Cystitis

Vaginitis
Urethritis
Pyelonephritis
Pregnancy
Pelvic Inflammatory Disease
STI's
Muscle strain
Malignancy

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What should be evaluated for Diagnostics of Cystitis

HPI
ROS
UA w/ dipstick
LABS- UA most accurate 
Pyuria abn >10 leukocytes

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Management of Cystitis

-Important to consider antimicrobial selection
- First line meds- Macrobid, Bactrim, Fosfomycin, Pivmecillinam, etc.
Alternative meds- other bata-lactams, Augmentin, or fluoroquinolones

what is needed if there is a suspected or high risk for resistance

Get a C&S and treat with meds empirically

Potential Complications of Cystitis

Pylonephritis
sepsis
Hospitalization
Death

Referral Considerations for Cystitis

Anytime it is a male pt
recurring UTI’s
Not responding to Antibiotics

Comorbidities of cystitis

Pregnancy, Older age, Chemotherapy, DM, Etc.

Most common cause of Urethritis in men

STI’s - Gonorrhea and chlamydia are the most common causes

How do we diagnose N. Gonorrhea

Easily seen on gram stain

Clinical Presentation of Urethritis

Dysuria #1 complaint
Can have discharge noted
ay have inflamed meatus on exam

Differential Diagnosis

Adults typically STI related- you must confirm

Potential Complications of Urethritis

Epididymitis and prostatitis in men. | Extragenital signs or symptoms

Referral Considerations of Urethritis

Typically can treat on own, may need referrals with refractory and/or more serious sx. Any other sexual contact within the past 60 days should be assessed and treated.

Urethritis Response to past treatment

- Patients with confirmed GC/Chlamydia should be rechecked in 3-6 months (bpth w/wo sx) - Test for cure 1-2 wks after tx recommended with culture or nucleic acid amplification test (NAAT)- typically only done if you use alternatie treatment or are worried about pt cure

Epidemiology of Pyelonephritis

15-17 cases per 10,000 females and 3-4 cases per 10000 males Estimated costs of pyelonephritis- at least 2.14 billion/yr

Etiology of Pyelonephritis

Infection of upper urinary tract typically comes one of 3 ways- ascending infection from bladder up ureters, infection from bacteremia called seeding, and possibly infection from bacteria in lymphatics to the kidneys

Clinical Presentation of pyelonephritis

Similar to UTI/Cystitis -Adults- Dysuria, frequency, urgency, suprapubic pain, hematuria possible, possible fever

Clinical presentation of Pyelonephritis

Fever, chills, flank pain, NV, CVA tenderness, mental status change, what about protein in urine

Differential Diagnosis of Pyelonephritis

UTI, STI, Kidney Stones, Hematuria, Lumbar injury, PID, etc.

Diagnostic evaluation of Pyelonephritis

``` Clean catch urine Suprapubic needle aspiration Catheterization Cultures if suspected CT MRI US PE/HPI/PMH ```

Management of Pyelonephritis | Uncomplicated

outpt single dose parenteral abx Oral abx Follow up in first 48 hours

Management of complicated Pyelonephritis

Inpt- Supportive care - follow results of urine and blood cultures - Monitor comorbid conditions - maintain hydration - Sx may be necessary- due to abscesses, necrosis, calculi related uti, and possibly needed nephrectomy

Potential complications of Pyelonephritis

``` Hospitalizations morbidity mortality sepsis acute renal failure scarring transplant pyelonephritis ```

How many cases or pyelonephritis are diagnosed in US alone per year

250,000 cases per year.

big differences from Pyelonephritis to UTI

Typically one side not both, Nausea and vomiting more prevalent in pye.

Referral Considerations for Pyelonephritis

Urology- ureteral obstruction, stones, urogenital abnomality, recurrent pyelo, first episode in a child or infant - renal specialist- acute renal failure or advanced chronic renal renal failure, all neonates and infants. - Infectious disease- unusual or resistant pathogen, immunocompromised pt, persistent fever (>48 hrs) or toxicity (>72 hrs) (+) blood culture results for more than 48 hours OB- consult if pt pregnant