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Clin med A 2 > UTI > Flashcards

UTI Flashcards

1
Q

What are the MC pathogens in UTIs

A

coliform bacteria especially E.Coli

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2
Q

what are the two types of UTIs

A

acute - 1 organism
chronic - may be 2+ organisms

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3
Q

what is the general diagnostic studies that are obtained for UTIs

A
  • colony count (>100,000 is suggestive but not diagnostic)
  • pyuria (presence of WBCs in urine)
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4
Q

how many women have low colony counts with UTIs

A

50%

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5
Q

who do you NOT screen for bacteriuria

A

children and women who are asymptomatic

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6
Q

what is asymtpmatic bacteriuria

A

colony counts of >100,000 with no symptoms. for diagnostic this must occur on 2 consecutive specimens

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7
Q

what is unresolved bacteriuria

A

result of failure to sterilize urinary tract during treatment of UTI

(resistance, noncomplaince to tx, mixed infections)

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8
Q

what is persistent bacteriuria

A

urinary tract is sterilized, but bacteriuria recurs due to persistent source of bacteria

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9
Q

what can cause persisten bacteriuria

A
  • infected stone
  • prostatitis
  • foreign bodies
  • fistulas
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10
Q

what is the MC method of UTI spread

A

“ascending”

bacterial ascent up through the urethra, bladder and ureters

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11
Q

why do women have higher incidence of UTI in women

A

shorter urethra causing increased susceptibility to ascending bacteria

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12
Q

what are other routes of infection for UTIs

A
  • ascending bacteria
  • direct extension from local tissues (intraperitoneal abscess)
  • hematgenosus (through blood, rare, s. aureus)
  • lymphatic (rare)
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13
Q

what are risk factors for UTIs

A
  • Abnormal voiding (including vesicoureteral reflux)
  • Diminished renal blood flow
  • Intrinsic renal disease
  • Abnormal urine pH, osmolality
  • Deficient mucosal coating
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14
Q

what are the factors that contribute to increased UTIs in women

A
  • shorter urethra
  • sexual intercourse “honeymoon cystitis”
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15
Q

what are factors that contribute to UTIs in men

A
  • prostatitis
  • foreskin
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16
Q

what is the MC bacteria in UTI

A

E. Coli!!

also see:
* proteus
* klebsiella
* pseudomonas
* staphylococci
* enterococci

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17
Q

what is hte epidemiology of acute cystitis

A

MC in women, rare in men

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18
Q

what are the symtpoms of acute cystitis

A
  • irritative coiding (dysuria, frequency, urgency)
  • suprapubic pain
  • +/- gross hematuria
  • +/- malaise
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19
Q

what are the PE findings of acute cystitis

A

suprapubic tenderness

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20
Q

what imaging is needed in acute cystitis

A

NONE!

(if male may wanna consider workup of underlying cause)

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21
Q

what are labs that can be found in acute cystitis

A
  • can skip UA if there are no s/s of systemic illness or risk factors for drug resistance
    BUT if you DO obtain one you will see:
  • pyuria
  • hematuria
  • bacteria
  • leukocyte esterase
  • urinary nitrite
  • positive bacterial culture
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22
Q

when would you obtain UA in acute cystitis

A

s/s of systemic illness

risk for drug resistant organisms

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23
Q

what are risks for Multiple drug resistant gram neg bacteria

A
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24
Q

what is the 1st line tx for acute cystitis

A
  • 5 days nitrofurantoin
  • 3 days bactrim or trimethoprim
  • single dose fosfomycin
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25
Q

what is the 2nd and 3rd line tx for acute cystitis

A
  • augmentin, cefpodoxime, cefdinir, cephalexin for 5-7 days (2nd line)
  • cipro or levo 3 days (3rd line)
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26
Q

if you are concerned about recurrent bacteria after tx of UTI what should you do?

A

repeat UA

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27
Q

what are urinary analgesics that can be used in acute cystitis

A
  • phenazopyridine (azo) after meals for 2 days
  • Methenamine
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28
Q

what is the MOA of Phenazopyridine (azo)

A

unknown

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29
Q

what are CI for Phenazopyridine (azo)

A
  • renal insufficiency
  • known allergy
30
Q

what are SE for Phenazopyridine (azo)

A
  • HA
  • dizziness
  • GI cramps
  • discolored urine

rare:
- AKI
- hemolytic anemia
- methemoglobiinemia

31
Q

what is a caveat for Phenazopyridine (Azo)

A
  • not for chronic or long term use
  • interferes with in-office UA dip
32
Q

what is MOA of methenamine

A

Metabolizes into formaldehyde and ammonia in urine
Some formulations have additives to acidify the urine or provide pain relief

33
Q

what are CI for methenamine

A
  • renal or severe liver insufficiency
  • allergy
  • severe dehyration
  • current tx with sulfanamides
34
Q

what are DDI for methenamine

A

Sulfa drugs

35
Q

what are SE for methenamine

A
  • rash
  • nausea
  • dyspepsia

rare:
- elevated LFTs

36
Q

what are supportive treatment additives for acute cystitis

A
  • Sitz baths
  • Increased PO fluid intake
  • Cranberry juice or supplement
  • Probiotics
  • Vaginal estrogen
37
Q

what are non pharmacollogical preventative measures for acute cystitis

A
38
Q

what are pharmacologic preventative measures for acute cystitis

A

low dose abx QHS or PRN with coitus (sexual intercourse)
such as:
* bactrim
* trimethoprim
* nitrofurantoin
* cephalexin
* methenamine

39
Q

when should pharmacologic preventative measures be considered

A

in women who have 3+ UTIs in.a 12 month period.

prior to starting tx r/o correctable underlying etiologies such as fistulas or kidney stones!!

40
Q

acute pyelonephritis is also known as

A

kidney infection

41
Q

what is the etiology of acute pyelonephritis

A
  • G- bacteria MC
  • E. coli, klebsiella, proteus, pseudomonas
  • G+ possible such as enterococci and staph
42
Q

what is the epidemiology for acute pyelonephritis

A

MC in women but less common in general than acute cystitis

43
Q

what are symptoms for acute pyelonephritis

A
  • irrative voiding
  • suprapubic pain
  • +/- gross hematuria
  • fever!!!!!!! (bolded in different color)
  • chills (bolded)
  • NVD (bolded)
  • flank pain (bolded)
44
Q

what would PE findings be for acute pyelonephritis

A
  • fever
  • tachycardia
  • CVA tenderness (bolded and in different color)
45
Q

what diabtes medications are likely to contribute to UTIs

A

SGLT2 inhibitors

46
Q

what imaging modalities are preferred in Acute pyelonephritis

A
  • not indicated in uncomplicated cases BUT if you do use:
  • CT (preferred, shows inflammation and abscesses)
  • US (shows hydronephrosis and maybe abscesses)
47
Q

what are the lab findings in acute pyelonephritis

A
  • pyuria
  • hematuria
  • bacteriuria
  • +/- WBC casts
  • urine culture + with heavy growth
  • CBC - leukocytosis and left shift
  • blood culture may or may not be +

total for order:
UA, urine culture, CBC and blood culture.

48
Q

what would indicate that a patient CAN be treated outpatient for acute pyelonephritis

A
  • tolerates PO fluids and meds
  • mild/mod s/s
  • uncomplicated
  • compliant with tx
49
Q

for outpatient therapy in the treatment of acute pyelonephritis, what is the treatment regimen? (not the actual meds)

A
  • oral abx +/- initial IV abx
50
Q

what are oral abx options for acute pyelonephritis

A
  • levo 5-7 days
  • cipro 7 days
  • bactrim 14 days
  • augmentin 10-14 days (not first line, dont use tbh)
51
Q

what abx CANNOT be used in tx for acute pyelonephritis

A
  • nitrofurantoin
  • oral fosfomycin
52
Q

what are initial IV options for abx treatment in acute pyelonephritis

A
  • ceftriaxone (rocephin) 1 dose
  • cipro 1 dose
  • gentamicin 1 dose
53
Q

what is indication for inpatient therapy in acute pyelonephritis

A
  • unable to do PO fluids/meds
  • severe illness s/s
  • complications (sepsis, obstruction)
  • non compliance
54
Q

for inpatient therapy in the treatment of acute pyelonephritis, what is the treatment regimen? (not the actual meds)

A

empiric tx based on risk of infection with MDR G- bacteria.

55
Q

if there are no risk factors for MDR G- bacteria, what abx could you use to treat inpatient acute pyelonephritis

A
  • IV ceftriaxone
  • IV pip/taz
  • IV amp/gent
  • IV or oral flouroquinolones
56
Q

if there are risks for MDR G+ bacteria, what abx could you use to treat inpatient acute pyelonephritis

A

add on one of the following:
- vanc
- linezolid
- daptomycin

57
Q

if there are 1+ risk factors for MDR G- bacteria, what abx could you use to treat inpatient acute pyelonephritis

A
  • Iv imipenem, meropenem, or doripenem
  • high resistent - IV ceph + BL inhibitor
58
Q

when can you switch inpatient acute pyelonephritis therapy to PO and how long will treatment last

A

May switch to PO as pt improves clinically and can tolerate PO intake - 14 d total tx

59
Q

what are possible complications for acute pyelonephritis

A
  • Sepsis/Septic shock
  • Scarring and nephron loss
  • Chronic pyelonephritis
  • Major renal abscess formation
60
Q

what is acute erethritis

A

inflammation of the urethra

61
Q

what is the etiology of acute urethritis

A
  • neisseria gonorrhoeae (MC)
  • chlamydia tachomatis (2nd MC)
  • mycoplasma genitalium (3rd MC)
  • could also see trichomonas vaginalis
62
Q

what are the 2 general classificiations of acute urethritis

A
  • gonococcal urethritis
  • non-gonococcal urethritis
63
Q

what is the epidemiology of acute urethritis

A

MC in young, sexually active males.

64
Q

what are symptoms of acute urethritis

A
  • irritative voiding
  • pain/pruritus at erethral meatus
  • urethral discharge
65
Q

what are PE findings for acute urethritis

A
  • +/- inflammation at urethral meatus
  • urethral discharge

(may have to “milk the urethra” for discharge, gross.)

66
Q

what percentage of acute urethritis is asymptomatic

A

Up to 10% of gonococcal urethritis and 42% of NGU

67
Q

what labs are present in acute urethritis

A
  • > 2 WBC/hpf is presumptive
  • G- intracellular diplococci suggests gonococcal
  • NAAT diagnosis chlamydia and gonorrhea
  • UA + WBCs esterase, pyuria, +/- hematuria of first stream sample

labs ordered: UA, Gram stain, NAAT

68
Q

what is the treatment for gonococcal acute urethritis

A

ceftriaxone (rocephin) 1 dose

69
Q

what isthe tx for chlamydial acute urethritis

A
  • azithromycin 1 dose
  • doxy x 7 days (preferred)

either can be used but doxy preferred.

70
Q

what is prophylactic treament for acute urethritis

A

all sexual partners must be treated and it must be reported to the health people.

71
Q

yay! all done

A

:)

Clin med A 2 (30 decks)

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