UTI Flashcards
2 most common pathogens in uncomplicated UTIs
e coli
staph saprophyticus
most common pathogen causing UTIs in diabetics
klebsiella
most common pathogen causing UTIs in people with indwelling catheters
pseudomonas
4 findings in clean catch UA, diagnostic for UTIs
- leukocytes esterase– indicates pyuria
- Nitrite
- hematuria
- bacteriuria
cultures NOT needed in uncomplicated UTIs
what test must be done if pt fails tx?
urine culture
if a pt has sx of UTI and gets a negative urine dipstick, what does this mean?
does not r/o infection! treat them anyway
what are the 3 first line meds used in uncomplicated
TMP-SMX DS 1 PO BID x 3 days
NTF 100 mg PO BID x 5 days
Fosfomycin 3g PO x 1 dose
what 3 meds should you avoid in pregnant people? which two are preferred
avoid: bactrim, cipro & NTF
preferred: amox of keflex
which medication causes pulm toxicity in elderly
NTF
2 major SE of quinolones
tendonitis or tendon rupture
hyperglycemia
which med should be taken with food
NTF
medication that causes discolored urine, hemolytic anemia, GI sx, rash, HA? (include dosing details)
Phenazopyridine (pyridium) 200mg PO TID PRN x 2 days dysuria
used to tx SYMPTOMS not the bacteria
med that causes anticholenergic sx, urinary retention w/ BPH
methenamine 2 tabs PO QID PRN x 2 days
deficiency of what hormone contributes to increased risk of UTIs in geriatric patients
estrogen
differentiate macrobid vs macrodantin
- macrobid 100mg BID x 5-7days; less GI ADR
- macrodantin 50-100mg PO QID x 5-7 days; more GI ADR; can be used prophylactically after intercourse of QHS
which medication should be avoided in pyelonephritis d/t negligible tissue penetration
NTF– also avoid in renal dysfunction
primary reason why NTF is on beers list
inadequate concentration in urine when CrCl is below 60ml/min
increased ADR– peripheral neuropathy, hepatotoxicity, pulmonary fibrosis and interstitial pneumonitis
rod shaped E. coli on swollen epithelial cells of bladder; epithelial surface secreted thick mucus filaments
bladder infection/cystitis
how are complicated UTIs treated?
same as uncomplicated UTI but for longer
when do you test for cure 3 wks later to confirm clearence
complicated or recurrent UTIs
these are risk factors for what?
- intercourse w/in 1 month
- maternal h.o UTI
- new sex partner in past yr
- spermicide use in past yr
- age of 1st UTI under 15 yo
recurrent UTI
how are recurrent UTIs treated
same as regulat but longer (1-2 wks) & do NOT use same abx as last time
also do culture!
what is the condition?
- evidence of UTI, fever, chills, flank pain, N/V, CVAT
- elderly & immunocompromised have atypical sxs (GI or pulm)
- misdiagnosis -> urosepsis, chronic pyelo, renal abscess, renal failure, HTN
acute pyelonephritis
what is the admission criteria for acute pyelonephritis (5)
- persistent vomiting
- suspected sepsis
- uncertain diagnosis
- urinary tract obstruction
- over 60, immunocompromised, poor social support, pregnant
acute pyelonephritis dx requires UA and confirmatory urine cultures. what are 2 expected findings??
- leukocyte esterase & +/- nitrite
- WBC (kidney inflammation)
- gram stain for abx therapy +/- blood cultures
4 first line tx of acute pyelonephritis
- cipro 500mg PO BID x 7 days +/- initial IV cipro 400 or ceftriaxone 1g
- cipro 1000mg ER PO Q day for 7 days
- Levo 750mg PO Q day x 5 days
- TMP-SMZ 1 PO BID x 14 days
tx for acute pyelo in pregnant patient
Augmentin 500/125mg PO TID x 10-14 days; can add Ceftriaxone 1g IV x 1 dose
what medication is not effective in pyelonephritis? how long should immunosuppressive pts be treated?
- never use NTF
- tx immunosuppressive pt for 21 days
how are UTIs in males treated?
Bactrim DS 1 (or fluoroquinolone) PO BID x 7-10 days
if its from STD, tx accordingly
- irritative voiding sx w/ negative urine culture in typically 30 to 70 yrs
- disrupts work, social relationships and sexual activity
- urgency/frequency, suprapubic pain, dysparunia, chronic pelvic pain
- sleep deprivation, depression, suicidal ideation
- sx worse in wk before menses; dietary association
interstitial cystitis
dx confirmed by cystoscopy findings (glomerulations or ulcers)
pinpoint hemorrhages seen w/ hydrodistention (can cause period of symptomatic relief)
glomerulations
results in bladder wall scarring & decreased capacity
hunner’s ulcers
- over 100K CFU/mL in asymp. pt in about 40% of elderly men and women
asymptomatic bacteruria
who benefits from treatment in asymptomatic bacteriuria (3)
- pregnant ppl
- renal transplant pt
- pt that undergo GU procedures
2 ways to tx urethral syndrome
doxycyline 100mg PO BID x 14 days
azithromycin 1g PO x 1 dose
which abx should be avoided in those taking warfarin? why?
bactrim– increases the INR!!
