Urinary tract infections Flashcards
epidemiology of UTIs
girls>boys due to poor wiping technique and short urethra
most common in sexually active females
pathophys of UTIs
via urethra bacteria ascends up urethra -fecal bacteria -lowered host defenses -residual urine nosocomial: instrumentation via blood/lymph/fistual
etiology of UTIS
E. coli most common,
proteus, klebsiella, serratia, enterobacter, staph saprophyticus, pseudomonas
risk factors for UTIs
- recurrent/previous UTI
- FH
- Intercourse
- indwelling catheter
- pregnancy
- personal hygiene
- contraceptive use
- atrophy
- obstruction
- incontinence
- urinary retention
- anatomic variant
- antibiotic use
- DM/immunosuppression
signs and symptoms of UTI
frequency, urgency, dysuria, suprapubic pain/tenderness, hematuria, odiferous urine
evaluation of UTI
physical: ab exam, CVA tenderness, pelvic exam, GU and DRE
labs for uti
UA/UC: clean catch, suprapubic aspiration, catheterization
Urinalysis findings UTI
positive leukocyte esterase
positive nitrites
micro: pyuria
UC findings
gold standard: 10^5 colonies or single species
indications for UC
young, old, recurrent, pregnant, immunosupression, pyelonephritis, prolonged sxs, recent abx use
other diagnostic tests for UTI
excretion urography (IVP): determines functional/anatomic abnormalities.
KUB w US: to define emptying, stones/obstructions
VCUG: determines abnl bladder emptying, reflux
cystoscopy: to exclude bladder lesions
patient education
describe ds pharm: OTC/abx fluids frequent/postcoital void proper wiping avoid constipation return if..
complicated UTI
abnormality -structure or function
can cause severe sequelae
septicemia more common
increased risk treatment failure
UTI sequelae
recurrent UTI-morbidity, renal disease urosepsis pyelonephritis proteinuria/HTN/renal function decline pregnancy complications
when do you refer UTI
recurrent childhood infections any UTI in males certain females -relapsing/recurrent/persistent -painless hematuria