Urinary Tract Infections

Question 1

Acute Cystitis

Answer 1

Bladder infection, UTI

Question 2

Acute Cystitis Etiology

Answer 2

Due to coliform bacteria (E coli) or G+ bacteria (enterococci)

• Infection ascends from urethra to bladder
• Rare in men and implies a pathologic process that requires further investigation

Question 3

Acute Cystitis S/S

Answer 3

Dysuria, urinary frequency, urgency, usually afebrile

• Gross hematuria
• Suprapubic tenderness

Question 4

Acute Cystitis Lab

Answer 4

UA: pyuria, hematuria, bacteriuria
-leukocyte esterase and nitrites
-WBCs and RBCs under scope
Urine culture: pos
Urine culture and sensitivity if empiric tx fails or an early relapse (less than 2 wks)

Question 5

Acute Cystitis Management

Answer 5

Tx: Trimethroprim/ Sulfamethoxazole x 3 days
or Nitrofurantoin x 5 days
-Fluoroquinolone in pts with allergy but areas have high rates of resistance

Symptomatic relief: hot sitz baths or urinary analgesics

Question 6

Acute Cystitis Prevention

Answer 6

-Complicated cases should be further investigated to determine the underlying cause
-Don’t use spermicide or diaphragm as birth control (for a variety of reasons…)
Women w/ 3+/year should get prophylactic abx therapy (single dose at bedtime or at time of intercourse)

Question 7

Recurrent Cystitis Etiology

Answer 7

• Occurs after a documented infection has resolved

- due to: genetic predisposition, altered vaginal flora, post coital infection

Question 8

Recurrent Cystitis S/S

Answer 8

Same as acute but quick relapse

Question 9

Recurrent Cystitis Lab

Answer 9

Urine culture and sensitivity

-consider urologic work up to evaluate anatomical abnormalities

Question 10

Recurrent Cystitis Management

Answer 10

Tx for 7-14 days

Question 11

Asymptomatic bacteriuria Etiology

Answer 11

More common with older age, spinal cord injuries, hemodialysis pts

Question 12

Asymptomatic bacteriuria S/S

Answer 12

No local or systemic symptoms can be present!!

-Usually discovered when undergoing unrelated urine culture screening

Question 13

Asymptomatic bacteriuria Lab

Answer 13

Urine culture pos without symptoms

Question 14

Asymptomatic bacteriuria Management

Answer 14

Do not treat!! Unless pregnant, before urologic intervention, prior to hip replacement, if they become symptomatic

Question 15

Pyelonephritis

Answer 15

Infectious inflammatory disease involving the kidney parenchyma and renal pelvis

Question 16

Pyelonephritis Etiology

Answer 16

Most common: E. coli, Proteus, Klebsiella, Enterobacter, Pseudomonas

Question 17

Pyelonephritis S/S

Answer 17

Must have: Fever, flank pain, irritative voiding

-shaking chills, N/V/D, urgency, frequency, dysuria, tachycardia, costovertebral tenderness, HA

Question 18

Pyelonephritis Lab

Answer 18

CBC
UA: pyuria, bacteriuria, hematuria, WBC casts
Urine culture: positive
US of bladder/kidney/ ureter to rule out obstruction

Question 19

Pyelonephtitis Management

Answer 19

Inpatient: IV ampicillin and an aminoglycoside until afebrile for 24 hrs then oral abx x 3 wks
Outpatient: fluoroquinolone x 2 wks

Question 20

Acute Bacterial Prostatitis Etiology

Answer 20

Usually caused by E coli or Pseudomonas

Question 21

Acute Bacterial Prostatitis S/S

Answer 21

Fever; irritative voiding; pelvic pain; ‘exquisite” tenderness on rectal exam; tender prostate
-pain with ejaculation

Question 22

Acute Bacterial Prostatitis Lab

Answer 22

Urine culture: pos
CBC: leurkocytosis and left shift
UA: pyuria, bacteriuria, hematuria

Question 23

Acute Bacterial Prostatitis Management

Answer 23

Fluoroquinolone or TMP-SMX x 2-4 wks
Acutely ill - admit for IV abx: ampicillin and gentamicin plus above tx
Consider testing for HIV and other STIs

Question 24

Acute Bacterial Prostatitis Prevention

Answer 24

Wear a condom with anal sex

Question 25

Chronic Bacterial Prostatitis Etiology

Answer 25

-Usually a result of bladder outlet obstruction G(-) rods Less commonly Enterococcus

Question 26

Chronic Bacterial Prostatitis S/S

Answer 26

Irritative voiding; dull and poorly localized low back, perineal or suprapubic discomfort; prostatic secretions - Can be asymptomatic - Many men have no history of acute infection!!

Question 27

Chronic Bacterial Prostatitis Lab

Answer 27

Culture secretions or postprostatic massage urine specimen | UA: normal unless 2nd cystitis

Question 28

Chronic Bacterial Prostatitis Management

Answer 28

``` Anti-inflammatory agent Tx: prolonged course of Fluoroquinolone or TMP-SMX -Refer to a urologist -Hot sitz bath -Relax pelvic floor with micturition ```

Question 29

Chronic Bacterial Prostatitis Prevention

Answer 29

Difficult to cure! | -Symptoms and recurrent UTIs can be controlled with suppressive abx therapy

Question 30

Epididymitis Etiology

Answer 30

Sexually transmitted: Chlamydia trachomatis or Neisseria gonorrhoeae Nonsexually: G(-) rods

Question 31

Epididymitis S/S

Answer 31

- Painful enlargement of the epididymis, relieved by scrotal elevation - Fever, irritative voiding, scrotal swelling - Pain in scrotum may radiate along spermatic cord - urethral discharge

Question 32

Epididymitis Lab

Answer 32

UA: pyuria, bacteriuria Sexually: gram stain of discharge, test for CT/GC Nonsexually: UA, urine culture

Question 33

Epididymitis Management

Answer 33

Sexually: abx x 10-21 days; treat partner Nonsexually: abx x 21-28 days; bed rest with scrotal elevation

Question 34

Epididymitis Prevention

Answer 34

Delayed or inadequate tx may result in epidiymorchitis, decreased fertility, or abscess formation