Urinary tract Infections Flashcards
Define :
bacteruria
UTI
Cystitis
Pyelonephritis
Funguria
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
Define uncomplicated , complicated UTIs, relapse , reinfection,recurrent
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
Examples of lower urinary tract infections
Cystitis , urethritis, prostatitis
Etiology of uncomplicated UTIs (pathogens)
E.Coli (80-90%)
K. Pneumonia
Proteus mirabili
Pseudomonas aeruginosa
Enterococcus
Staph saprophytic
Etiology of complicated UTI
E.coli
K.pneumonia
Proteus
Enterobacter
P. Aeruginosa
Enterococcus
What pathogens are patients with vancomycin resistant enterococci( VRE)
E.faecalis
E.faecium
Pathophysiology uti
Results from normal flora from bowel can gain entry into urinary tract by ascending up urinary tract , hematogenous route , lymphatic system
Diagnostic and treatment plan depends on (uti)
Location of UTI
Comorbidities such as diabetes
Complications such as nephrolithiasis
Resistance of organisms
Clinical presentation of Lower and upper UTIs
Lower-dysuria, nocturia, supra pubic tenderness, haematuria, urinary urgency
Upper -flank pain, fever , chills , N/V , malaise
What are some treatment concerns utis
Resistance to fluoroquinolones
Cotrimoxazole increased
Resistance of E.coli, E. Faecalis, proteus mirabilis
Diagnosis uti
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
Dipstick testing
Glucose, protein ,blood,nitrite , leukocyte esterases help screen UTIS
Speak on urine culture
Not needed in uncomplicated UTI(cystitis)
Criterion standard for diagnosis of UTIs
Especially for complicated UTIs, and failing initial /empiric therapy
What does it mean when patient has had UTI within month of treatment
Relapse probably due to treatment failure, obtain urine culture and perform gram stain for sensitivity
Characteristics sign of pyelonephritis
Fever
Severe flank pain
In elderly women cases of cystitis involve upper tracts
Physical examination uti
Dry mucous membrane ,tachycardia, symptomatic orthostasis is suggestive of poor vascular tone due to gram negative bacteremia
Why should pelvic exam be done(uti)
To exclude vaginitis, pelvic tenderness, cervicitis
Compare acute urethritis and cystitis
Urethritis-urethral discharge, fever , acute dysuria and urinary hesitancy
Cystitis-inflammation of bladder cause dysuria, polyuria,,incomplete voids with low back pain
Catheter-related infection signs
Fever and leukocytosis
Significant pyuria
Polymicrobial infections
What are infections of pregnant patients
(UTIs)
Asymptomatic bacteruria(ASB)
Predispose to preterm labor, anemia, hypertensive disorders
Risk factors for ASB(utis)
Sexual activity
Diabetes
History of UTIs
Complications UTIs patient with DM
Papillary necrosis
Fungal infections
Renal and perirenal abscess
Differentials utis
Herpes simplex
Vaginitis
Pelvic inflammatory disease
Bladder cancer
Non pharmacological management utis
Cranberry
Hydration
Diet
Indication for hospital admission for patients with complicated UTI
Complicated pyelonephritis
Metabolic disease(DM)
Immunocompromised
Structural abnormalities ie indwelling catheter
1st choice agents for treatment of uncomplicated acute cystitis
Nitrofurantoin
TMP-SMX
Fosfomycin
Alternative-beta lactams
FQ-complicated cystitis
Treatment of UTIs for uncomplicated
Give 1st, second line and alternative
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
Treatment for complicated 1st line and for patient who can’t tolerate oral therapy or possible resistance
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
Fungal infections
Replace catheter
Amphotericin B, 0.3mg/kg IV for 1 dose to provide sustained and systemic response
Discuss monitoring parameters utis
Clinical presentation ie fever
FBC ie TMP-SMX cause hematologic disturbance
Adr: Nitrofurantoin-hepatotoxicity, peripheral neuropathy
Cotrimoxazole - anemia, neutropenia, allergic rxn,
Speak on nitrofurantion
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
Fosfomycin
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
Cotrimoxazole
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
