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CLIN MED3: GU/Renal > Urinary Tract Infections > Flashcards

Urinary Tract Infections Flashcards

1
Q

what can bacterial UTI’s involve

A

urethra
prostate
bladder
or kidneys

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2
Q

what can be the symptoms of UTI

A

urinary frequency
urgency
dysuria
lower abd pain
flank pain
or may be asymptomatic

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3
Q

how are UTI’s diagnosed

A

urinalysis and urine culture

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4
Q

what is the treatment of UTI

A

antibiotic and removal of any urinary tract catheters and obstructions

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5
Q

what is the typical population affected by UTIs

A

Adults 20-50yo; 50x more common in females

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6
Q

what are female risk factors for the development of UTIs

A

sexual intercourse
diaphragm and spermicide use
new sex partner within past year
history of recurrent UTI’s
first UTI at early age
menopause

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7
Q

what increases the risk of UTI’s in both sexes

A

immunocompromised states
kidney stones or other blockages of urinary tract such as enlarged prostate, pelvic prolapse, or neurogenic bladder
congenital abnormalities of urinary tract
catheter use or recent urinary instrumentation/procedure

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8
Q

what is the most common pathogen for UTI

A

E.coli
gram neg: Klebsiella or P. mirabilis
Gram pos: S. saprophyticus

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9
Q

what is a complicated UTI

A

infection with factors that increase colonization and decrease efficacy of therapy (pregnant, post-menopause, male GU tract, DM)

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10
Q

what is cystitis or pyelonephritis

A

uncomplicated UTI: pre-menopause adult females with no structural or functional abnormality of urinary tract and who are not pregnant and have no significant comorbidity that could lead to more serious outcome

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11
Q

what is urethritis

A

urethral infectio with bacteria, protozoa, virus or funi

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12
Q

what is cystitis

A

infection of bladder

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13
Q

what is acute urethral syndrome

A

females
dysuria, frequency, and pyuria which resembles cystitis; urine cxs negative or low colony counts

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14
Q

what is acute pyelonephritis

A

bacterial infection of kidney parenchyma

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15
Q

what is the clinical presentation of urethritis

A

main symptom dysuria; in males, urethral discharge
-discharge: purulent, whitish or mucoid

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16
Q

what is the clinical presentation of cystitis

A

sudden onset frequency, urgency, burning/painful voiding, small volumes
-suprapubic pain common
-urine is turbid; microscopic hematuria may occur
-low-grade fever may develop

17
Q

what is the clinical presentation of acute pyelonephritis

A

same as cystitis (frequency, dysuria)
-fever, chills, flank pain, colicky abdominal pain, N/V
-tender, enlarged kidney may be palpable
-CVA tenderness usually present on infected side

18
Q

what is the most common UTI causative agent in a normal genitourinary tract

A

E. coli

19
Q

what is highly speicifc for UTI on dipstick

A

Nitrites

20
Q

if a female has repeated dysuria and pyuria but no bacteriuria what should be considered

A

urethral syndrome

21
Q

what do WBC casts on urine testing indicate

A

inflammatory reaction; pyelonephritis, glomerulonephritis, tubuloinerstitial nephritis

22
Q

when is urinary culture recommended

A

if complicated UTI or pathogen identification needed

23
Q

when is pathogen identification needed

A

pregnant patients
postmenopausal females
males
prepubertal children
urinary tract abnormalities or recent instrumentation
immunosuppression or significant comorbidities
symptoms suggest pyelonephritis or sepsis
recurrent UTIs (> 3/year)

24
Q

what is the typical antibiotics used for all symptomatic bacterial UTI

A

Fluoroquinolones
nitrofuratoin
TMP/SMX

25
Q

What is the treatment of urethritis

A

Ceftriaxone 250mg IM + Azithromycin 1g PO once
sex partners should seek treatment

26
Q

what is the treatment of umcomplicated cystitis

A

1st: Nitrofuratoin 100mg PO BID x 5 days or TMP/SMX PO BID for 3 days
2nd: Fluoroquinolones or beta-lactam abx

27
Q

what is the treatment of complicated cystitis

A

empiric broad-spectrum antibiotics on resistance patterns and culture results

28
Q

when can acute pyelonephritis be treated outpatient

A

pt are expected to be adherent
pt are immunocompetent
no N/V or evidence of volume depletion or septicemia
No factors suggesting complicated UTI

29
Q

what is the treatment of outpatient acute pyelonephritis

A

1st line: ciprofloxacin 500mg PO BID x 7 days; Levofloxacin 750 mg PO QD x 5days
2nd: TMP/SMX 160/800mg PO BID x 14 days

30
Q

what is the treatment for inpatient acute pyelonephritis

A

1st line: renally excreted fluoroquinniolones: cipro, levo
2nd line: ampicilin + gentamicin, broad-spectrum cephalosporins, aztrenam, beta-lactam

CLIN MED3: GU/Renal (11 decks)

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