Urinary Tract Infections Flashcards
What are the sxs of a lower UTI? upper UTI?
Dysuria, urgency, frequency, nocturia, and suprapubic heaviness
flank pain, fever, N/V, malaise
either can have gross hematuria
PE finding in upper UTI?
CVA tenderness
UTI lab findings?
pyuria (leukocytosis)
nitrite positive urine
leukocyte esterase positive urine
Presenting sxs for elderly pt with UTI?
freq. NO urinary sxs
AMS, change in eating habits, GI sxs
presenting sxs for UTI in patient with indwelling catheters or neuro disorders?
flank pain, fever
commonly will not have lower tract sxs
What types of tests can you use to check for a UTI
common dipstick- checks for nitrites
leukocyte esterase dipstick
urine culture - most reliable!
What can give you a false (-) for UTI on urine dipstick?
gram + organisms that do not reduce nitrate
low urine PH
freq voiding
dilute urine
What are the goals of UTI tx?
- get rid of invading organism
- prevent/tx systemic consequences of infx
- prevent recurrence
- decrease potential for damage with too broad of abx therapy
Most uncomplicated UTIs are caused by…
e. coli (75-95%)
Besides e coli, what other organisms can cause UTI?
Staphylococcus saprophyticus
Klebsiella pneumoniae
Proteus spp.
Pseudomonas aeruginosa
Enterococcus spp.
What can cause complicated UTIs?
gram (-) organisms
enterococcus faecalis
Tx for uncomplicated UTIs?
Trimethoprim-sulfamethoxazole (Bactrim) x3 days
or
Fosfomycin x 1 dose
or
Nitrofurantoin x 5 days
Fluroquinolones should be reserved for….. examples?
pyelonephritis or complicated infx
Ciprofloxacin
Levofloxacin
both x 3 d
ADEs of trimethoprim-sulfamethoxazole?
Rash, Stevens–Johnson Syndrome, renal failure, photosensitivity, hematologic (neutropenia, anemia, etc.)
What should you monitor on patient taking trimethoprim-sulfamethoxazole?
Serum creatinine, BUN, electrolytes, signs of rash, and CBC
trimethoprim-sulfamethoxazole works well for most aerobic enteric bacteria except…
p. aeruginosa
ADEs of Nitrofuratoin?
GI intolerance, neuropathies, and pulmonary reactions
main advantage of Nitrofurantoin?
lack of resistance even after long courses of therapy
ADEs of Fosfomycin trometamol?
diarrhea, HA, angioedema
ADEs of Fluroquinolones: ciprofloxacin/levofloxacin?
Hypersensitivity, photosensitivity, GI symptoms, dizziness, confusion, and tendonitis (black box warning)
When should you avoid fluroquinolones?
pregnancy and children
What is the preferred penicillin for uncomplicated cystitis?
amoxicillin-clavulanate
When should you avoid trimethoprim-sulfamethoxazole?
during 3rd trimester of pregnancy
What pathogens cause prostatitis?
E. coli
K. pneumoniae
Proteus spp.
P. aeruginosa
Tx for prostatitis?
Trimethoprim–sulfamethoxazole × 4-6wks
Quinolone × 4-6 wks
Presentation of stevens-Johnson syndrome?
begins with flu sxs
facial/tongue swelling, hives, skin pain
red/purple skin rash that spreads within hrs to days, blisters on skin, mm, eyes, nose, genitals
shedding of your skin
role of cranberry juice in UTIs?
lactobacillus potentially helps keep vag PH norm
possible benefits in sexually active adult women with recurrent UTIs by decreasing adherence of bacteria to bladder epithelial cells
What is Phenazopyridine HCL
urinary anesthetic/analgesic
Azo dye, no antimicrobial properties
brand: Pyridium, Uristat, Azo-standard
Potential consequence to using Phenazopyridine HCL?
may mask s/s of UTI not responding to antimicrobial therapy
ADEs of Phenazopyridine HC
red-orange discoloration of body fluids
rash, anaphylaxis, rare hemolytic anemia, methemoglobinemia, acute renal failure
When should you tx for UTI in pregnancy? What can you use?
if pt has significant bacteriuria, regardless of sxs
7 day course of one:
Cephalexin
Amoxicillin
Amoxicillin/clavulanate
