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D&D Infectious Disease Midterm > Urinary Tract Infections Part 1 > Flashcards

Urinary Tract Infections Part 1 Flashcards

1
Q

definition of a urinary tract infection

A

presence of microorganisms in the urinary tract (that can’t be accounted for by contamination)

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2
Q

what is the most common bacterial infection AND the most common reason for antibiotic exposure

A

urinary tract infection

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3
Q

around 60% of females will develop a UTI in their lifetime and ____% will have a recurrence within _____

A

25% within a year

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4
Q

true or false

urinary tract infections are always more common in women, regardless of age

A

false

rates are much higher in women, but up until men reach 65 yrs - at this point their rates are similar to women

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5
Q

urinary tract infections encompass a wide spectrum of clinical entities

explain this

A

UTI’s can range from an asymptomatic infection – acute pyelonephritis (kidneys) — sepsis

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6
Q

what is an upper UTI

A

pyelonephritis - kidney infection

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7
Q

what is a lower UTI

A

could be 3 things –

-cystitis (bladder)
-urethritis (urethra)
-prostatitis (prostate gland)

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8
Q

2 ways UTIs can be classified

A

complicated or uncomplicated

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9
Q

define uncomplicated vs complicated UTI in terms of who they affect

A

uncomplicated - affects premenopausal women of childbearing age (15-45) who are NORMAL and HEALTHY

complicated – UTI in anyone else (ie - any male)

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10
Q

differentiate between uncomplicated vs complicated UTI based on what they AFFECT

A

uncomplicated - there are no structural or functional abnormalities of the urinary tract that affect the normal flow of urine

complicated - result of a predisposing factor like a congenital abnormality/distortion of urinary tract, a stone obstruction, or some neurological deficit that INTERFERES WITH THE FLOW OF URINE

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11
Q

2 main causes of outpatient UTIs

A

e. coli (MOST - 75-90% of outpatient cases!!)

second is staph saprophyticus in young women (18-22)

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12
Q

which bacteria is usually a contaminant in urine samples

A

staph epidermidis

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13
Q

2 bacteria that commonly cause UTI IN hospitalized patients

A

pseudomonas and enterococcus

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14
Q

2 gram negative bacteria that can cause UTI (not pseudomonas and enterococcus)

A

klebsiella pneumoniae
proteus

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15
Q

which bacteria usually causes bacteremia and kidney abscess

A

staph aureus

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16
Q

generally differentiate between symptoms of a lower UTI vs upper

A

lower UTI has more localized symptoms like pain when urinating and urgency

upper UTI has those same symptoms but more constitutional symptoms as well like fever nausea, vomiting, malaise

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17
Q

TRUE OR FALSE

symptoms alone are not a sufficient way to diagnose a UTI

A

true. symptoms can be used to differentiate upper and lower, but not to diagnose a UTI itself

must have a good urine specimen AND SYMPTOMS

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18
Q

“gold standard” to diagnose a UTI

A

a positive urinalysis with a positive urine culture in a SYMPTOMATIC patient

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19
Q

what is usually the initial step of diagnosing a UTI?

what is done to confirm diagnosis?

A

initial step is urinalysis

urine culture is done to confirm, but NOT routinely done in outpatient settings for uncomplicated cystitis because MOST OF THE TIME it’s gonna be e. coli anyway

HOWEVER, urine cultures are done to confirm in pyelonephritis (upper - kidney), when treatment isn’t working, or when the patient has atypical symptoms

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20
Q

3 methods of urine collection and which is preferred

A
  1. midstream clean-catch method (preferred)

also catheterization and suprapubic bladder aspiration

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21
Q

explain the midstream clean-catch method

A

clean urethral opening and discard initial 20-30mL of urine

collect the midstream void and process immediately OR refrigerate if you can’t do so

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22
Q

catheterization is done to collect urine in which patients?

what is a potential issue with this method of collecting urine

A

pts who are uncooperative or unable to pee

issue is that it may introduce bacteria into the bladder – causes 1-2% of bladder infections

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23
Q

in what patients is suprapubic bladder aspiration done to collect urine?
explain the method

A

the needle is inserted directly into the bladder to aspirate the urine

its safe and painless and bypasses any contaminating organisms in the urethra

done in bbs, paraplegics (leg paralysis), and very ill patients
-these patients NEED a reliable sample to make clinical decisions

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24
Q

what does a urine culture do

A

identifies the organisms and provides the susceptibilities

(THATS IT- EVERYTHING ELSE LIKE BACTERIURIA AND HEMATURIA ARE URINALYSIS)

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25
Q

define bacteruria

A

when >100,000 CFU/mL of urine

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26
Q

what is pyuria

A

WBC in urine

> 10WBC/mm3

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27
Q

what does “nitrite positive” mean and what detects this

A

detected in urinalysis

some bacteria (like e. coli) are able to reduce nitrates to nitrite — nitrite positive indicates presence of such bacteria

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28
Q

what value in a urinalyis helps to identify if the patient is hydrated/dehydrated

what is reference range??

A

specific gravity

1.001-1.035

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29
Q

what component of a urinalysis is a marker for white blood cells in the urine (pyuria)

A

leukocyte esterase

30
Q

what is a marker for common bacterial pathogens in a urinalysis?

A

nitrite

31
Q

name 3 bacteria that DO reduce nitrate to nitrite and 3 bacteria that do NOT

A

DO - e. coli, klebsiella, proteus

DONT - pseudomonas, enterococci, coagulase negative staph

32
Q

are WBC and RBC found in the dipstick or microscopic portion of a urinalysis

A

microscopic

33
Q

bacteria are too numerous to count - is this consistent with a urinary tract infection?

A

YES

34
Q

epithelial cells are too numerous to count in microcopic portion of a urinalysis - is this consistent with a urinary tract infection?

A

NO

this most likely indicates a contaminated culture

35
Q

TRUE OR FALSE

urinalysis and urine cultures are only useful when also used in conjunction with symptoms

A

TRUE

bc there are many factors that can affect urinalysis results that are not bc of infection

ie - for postmenopausal women it is normal to have inflammation in urinary tract - normal for them to have high WBC and leukocyte esterase

36
Q

urine collected should be testes or cultured within _______ of collection to avoid _____

A

within 20 mins of collection to avoid erroneously high bacteria counts

if unable to do within 20 mins, referigerate until testes

37
Q

4 treatment goals for UTIs

A

-get rid of infecting organism(s)

-prevent/treat systemic consequences of the UTI

-prevent infection from recurring

-decrease the potential for collateral damage when we use broad spectrum antibiotics

38
Q

as mentioned, 1 of the treatment goals for UTIs is to limit the collateral damage when we use broad spectrum antibiotics

name 2 components of this potential collateral damage

A
  • breeds resistance - unwanted colonization and infection with multidrug resistant organisms

-impact on gut flora - can cause c diff

39
Q

3 components of overall management of UTIs

A

initial evaluation
empiric antibiotics
follow up

40
Q

true or false

test-of-cure is not recommended for UTIs

A

true

dont resend the urine to confirm infection cleared. if they feel better - it’s good enough

41
Q

e. coli has been increasing its resistance to which class of antibiotics

A

fluoroquinolones - particularly cipro

42
Q

true or false

the overall resistance rates for e. coli are higher in the US than they are in canada

A

true

43
Q

what are some risk factors for a patient having e.coli bacterial resistance?
(within the prior 3 months of starting the antibiotic)

A

have a history of multi-drug resistant organisms

recently have used broad spectrum antibiotics

healthcare exposures

travel to parts of world where MDRO’s are prevalent

44
Q

to optimize empiric therapy in terms of avoiding the issue of resistance, what is necessary?

A

have to ongoingly monitor the LOCAL prevalence of resistance

USING ANTIBIOGRAMS

45
Q

prior to starting antibiotics, do what 2 things

A

collect urine for urinalysis and urine culture (if complicated)

46
Q

3 1st line options for empiric treatment for uncomplicated cystitis

A

nitrofurantoin
bactrim
fosfomycin

47
Q

true or false

e. coli is usually very susceptible to nitrofurantoin

A

true

48
Q

dose of nitrofurantoin for uncomplicated cystitis

A

100mg Q12 5 days

49
Q

dose of bactrim for uncomplicated cystitis

A

1 tab q12 3 days

50
Q

dose of fosfomycin for uncomplicated cystitis

A

3g PO for 1 dose

51
Q

true or false

nitrofurantoin has a lot of resistance issues

A

FALSE - minimal resistance

52
Q

in which particular UTI is nitrofurantoin AVOIDED

A

pyelonephritis

53
Q

most common ADR of nitrofurantoin

which 2 are really only seen wiith long term use

A

GI intolerance

neuropathies and pulmonary toxicity

54
Q

ADRS of bactrim

A

rash (sjs)
hyperkalemia
photosensitivty
hematologic (pancytopenia)

55
Q

which 1st line drug for uncomplicated cystitis is avoided if the local resistance prevalence is greater than 20%??

A

bactrim

56
Q

aside from not using bactrim when local resistance prevalence is greater than 20%, when else should bactrim be avoided for UTI

A

if it was used for UTI in previous 3 months (resistance)

57
Q

what is the only 1st line for uncomplicated cystitis that CAN be used for pyelonephritis

A

bactrim

fosfomycin and nitrofurantoin can’t

58
Q

ADR fosfomycin

is it used often? explain

A

diarrhea, headache, angioedema (but generally well tolerated)

it retains activity against multi drug resistant organisms, so not really given to anyone other than those with a MDRO

also expensive

59
Q

which 1st line for uncomplicated UTI is avoided in creatinine clearance less than 30mL/min

A

nitrofurantoin

60
Q

monitoring parameters for nitrofurantoin

A

serum creatinine and BUN

61
Q

monitoring parameters for bactrim

A

serum creatinine, bun, electrolytes (potassium), and watch for rash

62
Q

what if the 3 first line options for acute uncomplicated cystitis cannot be used??
explain

(nitrofurantoin, bactrim, or fosfomycin (if MDRO))

A

use fluoroquinolones (but bad resistance profile) or beta lactams (but avoid ampicillin or amoxicillin alone - less effective than other agents)

63
Q

a patient’s urinalysis and symptoms are consistent with UNCOMPLICATED CYSTITIS

allergy to sulfa. when antibiotic regimen is most appropriate

A

nitrofurantoin 100mg Q12H 5 days

64
Q

true or false

both macrobid and fosfomycin CANNOT BE USED for pyelonephritis

A

TRUE

65
Q

true or false

in clinical practice, fluoroquinolones are used for empiric treatment of acute pyelonephritis

A

FALSE

this is recommended in the guidelines, but NOT DONE IN CLINICAL PRACTICE

serious side effects. risks outweigh benefits.
tendon rupture, hypoglycemia, neuro effects, peripheral neuropathies, QT prolongation

ONLY RESERVED FOR THOSE WITH NO OTHER OPTIONS

66
Q

though quinolones are recommended in the guidelines for outpatient acute pyelonephritis, they are not used

what is used in clinical practice instead?

A

if FQ resistance greater than 10%, ceftriazone 1g IV/IM for one dose OR gentamicin/tobramycin 5mg/kg IV/IM for one dose

or

bactrim Q12H for 14 days IF THE PATHOGEN IS KNOWN TO BE SUSCEPTIBLE

if not, potentially beta lactams, but they’re less effective for pyelonephritis. if we use them PO, first must give initial dose of long acting IV antibiotic like ceftriaxone

67
Q

indications for hospitalization for acute pyelonephritis

A

sepsis
persistent high fever
severe pain
urinary obstruction

68
Q

empiric treatment for pyelonephritis in HOSPITALIZED PATIENT

A

3 options - all IV

most often it’s ceftriaxone 1g (ext spectrum cephalosporin) BC IT’S NARROWEST OF THE 3 EMPIRIC OPTIONS - OTHER 2 ARE BROAD

could be aminoglycoside (genta or tobra 5mg/kg)

carbapenem - drug of choice for ESBL (etrapenem 1g)

69
Q

very important consideration when choosing treatment for pyelonephritis in hospitalized patient AND outpatient pyelonephritis

A

FOLLOW THE CULTURES AND SUSCEPTIBILITIES

(complicated)

70
Q
A

D&D Infectious Disease Midterm (26 decks)

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