Urinary tract Infections Flashcards

1
Q

Define :
bacteruria
UTI
Cystitis
Pyelonephritis
Funguria

A

Bacteriuria presence of bacteria in urine
UTIS -presence of microbes in urine that can Invade structures and tissues of urinary tract and surrounding areas
Cystitis-inflammation of bladder d/t infection
Pyelonephritis-affect kidneys and upper urinary tract
Funguria-presence of fungi/yeast in urine

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2
Q

Define uncomplicated , complicated UTIs, relapse , reinfection,recurrent

A

Uncomplicated- occur in healthy men and women with completely normal genitourinary systems
Complicated- infections interfere with normal urine flow can be due to stones, catheter
Recurrent UTI->3 episodes /year with asymptomatic periods in between
Relapse -same pathogen
Reinfection-different pathogens

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3
Q

Examples of lower urinary tract infections

A

Cystitis , urethritis, prostatitis

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4
Q

Etiology of uncomplicated UTIs (pathogens)

A

E.Coli (80-90%)
K. Pneumonia
Proteus mirabili
Pseudomonas aeruginosa
Enterococcus
Staph saprophytic

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5
Q

Etiology of complicated UTI

A

E.coli
K.pneumonia
Proteus
Enterobacter
P. Aeruginosa
Enterococcus

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6
Q

What pathogens are patients with vancomycin resistant enterococci( VRE)

A

E.faecalis
E.faecium

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7
Q

Pathophysiology uti

A

Results from normal flora from bowel can gain entry into urinary tract by ascending up urinary tract , hematogenous route , lymphatic system

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8
Q

Diagnostic and treatment plan depends on (uti)

A

Location of UTI
Comorbidities such as diabetes
Complications such as nephrolithiasis
Resistance of organisms

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9
Q

Clinical presentation of Lower and upper UTIs

A

Lower-dysuria, nocturia, supra pubic tenderness, haematuria, urinary urgency

Upper -flank pain, fever , chills , N/V , malaise

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10
Q

What are some treatment concerns utis

A

Resistance to fluoroquinolones
Cotrimoxazole increased
Resistance of E.coli, E. Faecalis, proteus mirabilis

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11
Q

Diagnosis uti

A

Dipstick diagnosis- cost effective, use midstream urine culture asses elevated nitrites and wbc
Urine culture - for elderly women, cystitis in Immunocompromised, exposure to antibiotics
Bacteremia associated with pylenephritis
Urinalysis-proteinuria

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12
Q

Dipstick testing

A

Glucose, protein ,blood,nitrite , leukocyte esterases help screen UTIS

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13
Q

Speak on urine culture

A

Not needed in uncomplicated UTI(cystitis)
Criterion standard for diagnosis of UTIs
Especially for complicated UTIs, and failing initial /empiric therapy

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14
Q

What does it mean when patient has had UTI within month of treatment

A

Relapse probably due to treatment failure, obtain urine culture and perform gram stain for sensitivity

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15
Q

Characteristics sign of pyelonephritis

A

Fever
Severe flank pain
In elderly women cases of cystitis involve upper tracts

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16
Q

Physical examination uti

A

Dry mucous membrane ,tachycardia, symptomatic orthostasis is suggestive of poor vascular tone due to gram negative bacteremia

17
Q

Why should pelvic exam be done(uti)

A

To exclude vaginitis, pelvic tenderness, cervicitis

18
Q

Compare acute urethritis and cystitis

A

Urethritis-urethral discharge, fever , acute dysuria and urinary hesitancy
Cystitis-inflammation of bladder cause dysuria, polyuria,,incomplete voids with low back pain

19
Q

Catheter-related infection signs

A

Fever and leukocytosis
Significant pyuria
Polymicrobial infections

20
Q

What are infections of pregnant patients
(UTIs)

A

Asymptomatic bacteruria(ASB)
Predispose to preterm labor, anemia, hypertensive disorders

21
Q

Risk factors for ASB(utis)

A

Sexual activity
Diabetes
History of UTIs

22
Q

Complications UTIs patient with DM

A

Papillary necrosis
Fungal infections
Renal and perirenal abscess

23
Q

Differentials utis

A

Herpes simplex
Vaginitis
Pelvic inflammatory disease
Bladder cancer

24
Q

Non pharmacological management utis

A

Cranberry
Hydration
Diet

25
Q

Indication for hospital admission for patients with complicated UTI

A

Complicated pyelonephritis
Metabolic disease(DM)
Immunocompromised
Structural abnormalities ie indwelling catheter

26
Q

1st choice agents for treatment of uncomplicated acute cystitis

A

Nitrofurantoin
TMP-SMX
Fosfomycin
Alternative-beta lactams
FQ-complicated cystitis

27
Q

Treatment of UTIs for uncomplicated
Give 1st, second line and alternative

A

1st line :1.cotrimoxazole DS 1 tab PO q12h for 3 days
Nitrofurantoin 100mg q12h 5-7 days
Fosfomycin 3g PO with 125 ml of water
Second line : levofloxacin 250mg PO q24h for 3 days
Alternative -cefuroxime 200mg q12 7-10 days
Amox/clav 500/125mg q12 for 3-7 days

28
Q

Treatment for complicated 1st line and for patient who can’t tolerate oral therapy or possible resistance

A

1st- levofloxacin 750mg q24 for 5 days

Parenteral for pt can’t tolerate
Levofloxacin 750 mg IV for 5 days
Pip-tazo 3.375 g IV q6h
Imipenem-cilastin 500mg IV q6h for 7-14 days

29
Q

Fungal infections

A

Replace catheter
Amphotericin B, 0.3mg/kg IV for 1 dose to provide sustained and systemic response

30
Q

Discuss monitoring parameters utis

A

Clinical presentation ie fever
FBC ie TMP-SMX cause hematologic disturbance
Adr: Nitrofurantoin-hepatotoxicity, peripheral neuropathy
Cotrimoxazole - anemia, neutropenia, allergic rxn,

31
Q

Speak on nitrofurantion

A

MOA: interfere cell wall synthesis, by interfering with bacterial enzymes involved in metabolism of pyruvate
Spectrum: gram +/- , e.coli, S.saprophyticus
Admin:oral
Side effects: pulmonary toxicity, peripheral neuropathy, GIT , peripheral neuropathy
Good for uncomplicated UTIs

32
Q

Fosfomycin

A

MOA: inhibits cell wall synthesis by interfering with peptidoglycan formation
Spectrum : gram+/- , resistant strains , E. Coli
Dosing orally/IV
Side effect : well tolerated , git symptoms
Decreased resistance, good for uncomplicated UTIs

33
Q

Cotrimoxazole

A

MOA: inhibit sequential steps for bacterial folic acid synthesis, inhibit DNA synthesis
Spectrum: broad spectrum, gram +/- , E.coli , S. Aureus
Admin: orally
S/E : neutropenia, anemia, Steven Johnson , allergic rxn, neutropenia
Good for prophylaxis, used in management both complicated and uncomplicated UTIs including prostatitis
Drink with lots of water