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PR3124 CA2 > UTI > Flashcards

UTI Flashcards

1
Q

what causes symptomatic infection?

A

when micro org invade tissues of urinary tract and adjacent structures, leading to inflammatory response

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2
Q

Enterobacteriaceae family includes

A

Escherichia coli, Klebsiella, Proteus
- gut gram negative bacilli
(ascending route of infection, colonic/fecal flora)

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3
Q

Eg. of organisms arising from descending (hematogenous) route of infection?

A

Staphylococcus aureus, Mycobacterium tuberculosis

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4
Q

factors determining development of UTI

A
  1. competency of natural host defense
  2. size of inoculum
  3. virulence/pathogenicity of the microorg
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5
Q
  1. natural host defense
A
  • bacteria in bladder stimulates micturition, increasing diuresis, emptying of bladder
  • antibacterial properties of urine and prostate secretions
  • anti-adherence mechanisms of bladder mucosa, prevent bacterial attachment, unable to invade tissues to cause infection
  • inflammatory response with polymorphonuclear leukocytes, phagocytosis, prevent/control spread
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6
Q
  1. size of innoculum
A

incr with obstruction/urinary retention

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7
Q
  1. virulence/pathogenicity of microorg
A

eg. bacteria with pili such as E.coli, resistant to washout or removal by anti-adherence mechanisms of the bladder

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8
Q

risk factors for UTI (11)

A
  1. f>m
  2. sexual intercourse
  3. abnormalities of urinary tract
  4. neurological disturbances
  5. anti-cholinergic drugs
  6. catheterization and other mechanical instrumentation
  7. diabetes
  8. pregnancy
  9. use of diaphgrams and spermicides
  10. genetic assoc (pos family history)
  11. previous UTI
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9
Q

what are some atypical and subtle smx of complicated UTI?

A

oweing to catheterisation, impaired sensation, altered mental status

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10
Q

does antimicrobial resistance warrant the designation of complicated UTI?

A

No, though multidrug resistance common in complicated UTI
- uncomplicated: healthy, ambulatory women with no history suggestive of anatomical or functional abnormality of the urinary tract

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11
Q

What kind of subjective smx does elderly present with?

A

Frequently unspecific smx ie. altered mental status (drowsy, less alert, change in eating habits, GI)

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12
Q

Urinalysis

A

UFEME, chemical analysis

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13
Q

WBC threshold for pyuria

A

> 10WBCs/mm3

  • signifies presence of inflammation, may or may not be due to infection
  • unlikely pyruia = unlikely UTI
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14
Q

What does presence of WBC cast indicate?

A

masses of cells and proteins that form in renal tubules (in kidney), indicate upper tract infection/disease

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15
Q

What does presence of squamous epithelial cells in UFEME indicate?

A

High level of contamination, urine sample not well collected

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16
Q

Empiric first line abx for uncomplicated cystitis in women (CA)

A

PO co-trimoxazole 800/160mg bid x3d
PO nitrofurantoin 50mg qid x5d
PO fosfomycin 3g single dose

17
Q

Alternative abx for uncomplicated cystitis in women (CA)

A

PO beta-lactams x3-7d

  • cefuroxime 250mg bid
  • cephalexin 500mg bid
  • amoxi/clav 625mg bid

PO fluoroquinolones x3d

  • ciprofloxacin 250mg bid - good resolution rate, but concern of collateral damage (last line)
  • levofloxacin 250mg daily
18
Q

HA/complicated UTI org

A

E.coli, Enterococci

Klebsiella spp, Proteus spp, Pseudomonas aeruginosa, Enterobacter spp

19
Q

HA/complicated UTI org

A

50% E.coli
Enterococci (gram pos)
Klebsiella spp, Proteus spp, Pseudomonas aeruginosa, Enterobacter spp (gram neg)

20
Q

Staphylococcus aureus

A

commonly due to bacteremia, consider other primary sites of infection

21
Q

Yeast or Candida

A

commonly present in colonal bowel, possible contaminants, or consider other sites of infection

22
Q

Treatment for complicated cystitis in women

A

Treat for longer duration eg 7-14 days

fosfomycin dos: PO 3g EOD x3 doses

23
Q

Empiric abx for CA pyelonephritis in women

A

PO fluoroquinolones (first line) - shorter duration hence benefits>risks:

  • ciprofloxacin 500mg bid x7d
  • levofloxacin 750mg daily x5d

PO cotrimoxazole 960mg bid x14d

PO beta-lactams x10-14d:

  • cephalexin 500mg bid
  • amoxi/clav 625mg tds
24
Q

For severely ill patients who require hospitalisations or who are unable to take oral drug (pyelonephritis)

A

consider IV therapy:
IV ciprofloxacin 400mg bid or IV cefazolin 1g q8h or IV amoxi/clav 1.2g q8h
and/or
IV/IM gentamicin 5mg/kg, cover for ESBL-producing Klebsiella and E.coli
then switch to oral when pt improve or able to take orally

25
Q

Empiric abx for nosocomial/healthcare-assoc pyelonephritis

A

possibility of Pseudomonas aeruginosa and other resistant bacteria eg ESBL producing E.coli and Klebsiella

IV cefepime 2g q12h +/- IV amikacin 15mg/kg/d
IV imipenem 500mg q6h or IV meropenem 1g q8h
PO ciprofloxacin 500mg bid
PO levofloxacin 750mg
- consider oral options for less sick patients

7-14d

26
Q

Empiric abx for CA-UTI in men

A

for cystitis, if no concern for prostatitis, treat as per complicated cystitis (7-14d) in women
cystitis with concern for prostatitis or pyelonephritis:
PO co-trimoxazole 960mg bid, 10-14d
PO ciprofloxacin 500mg bid x10-14d

Will need longer duration if prostatitis is confirmed (6 weeks)

27
Q

Most common cause of nosocomial UTI

A

catheter-assoc UTI

28
Q

Causative organisms of catheter-assoc UTI

A 
short term (<7d) - 85% single org, reflecting that prevailing in envi
long term (>28d) - 95% polymicrobial ie 2-3 org
29
Q

When is treatment of asymptomatic bacteriuria for catheter-assoc UTI recco?

A

Prior to traumatic urological procedures

30
Q

Catheter-assoc UTI smx

A

fever, rigors, altered mental status, malaise, lethargy with no other identified cause, flank pain, costovertebral angle tenderness, acute hematuria, pelvic discomfort

31
Q

Empiric abx for catheter-assoc UTI

A

IV imipenem 500mg q6h or IV meropenem 1g q8h
IV cefepime 2g q12h +/- IV amikacin 15mg/kg (1dose)
PO/IV levofloxacin 750mg x5d (for mild cases)
PO co-trimoxazole 96-mg bid x3d (for women =< 65yo with catheter-uti wo upper urinary tract smx after an indwelling catheter has been removed)

usually 7days with prompt resolution fo smx (deferverse in 72hrs) and 10-14d for those with delayed treatment

PR3124 CA2 (6 decks)

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