UTI Flashcards
What are the MC pathogens in UTIs
coliform bacteria especially E.Coli
what are the two types of UTIs
acute - 1 organism
chronic - may be 2+ organisms
what is the general diagnostic studies that are obtained for UTIs
- colony count (>100,000 is suggestive but not diagnostic)
- pyuria (presence of WBCs in urine)
how many women have low colony counts with UTIs
50%
who do you NOT screen for bacteriuria
children and women who are asymptomatic
what is asymtpmatic bacteriuria
colony counts of >100,000 with no symptoms. for diagnostic this must occur on 2 consecutive specimens
what is unresolved bacteriuria
result of failure to sterilize urinary tract during treatment of UTI
(resistance, noncomplaince to tx, mixed infections)
what is persistent bacteriuria
urinary tract is sterilized, but bacteriuria recurs due to persistent source of bacteria
what can cause persisten bacteriuria
- infected stone
- prostatitis
- foreign bodies
- fistulas
what is the MC method of UTI spread
“ascending”
bacterial ascent up through the urethra, bladder and ureters
why do women have higher incidence of UTI in women
shorter urethra causing increased susceptibility to ascending bacteria
what are other routes of infection for UTIs
- ascending bacteria
- direct extension from local tissues (intraperitoneal abscess)
- hematgenosus (through blood, rare, s. aureus)
- lymphatic (rare)
what are risk factors for UTIs
- Abnormal voiding (including vesicoureteral reflux)
- Diminished renal blood flow
- Intrinsic renal disease
- Abnormal urine pH, osmolality
- Deficient mucosal coating
what are the factors that contribute to increased UTIs in women
- shorter urethra
- sexual intercourse “honeymoon cystitis”
what are factors that contribute to UTIs in men
- prostatitis
- foreskin
what is the MC bacteria in UTI
E. Coli!!
also see:
* proteus
* klebsiella
* pseudomonas
* staphylococci
* enterococci
what is hte epidemiology of acute cystitis
MC in women, rare in men
what are the symtpoms of acute cystitis
- irritative coiding (dysuria, frequency, urgency)
- suprapubic pain
- +/- gross hematuria
- +/- malaise
what are the PE findings of acute cystitis
suprapubic tenderness
what imaging is needed in acute cystitis
NONE!
(if male may wanna consider workup of underlying cause)
what are labs that can be found in acute cystitis
- 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
when would you obtain UA in acute cystitis
s/s of systemic illness
risk for drug resistant organisms
what are risks for Multiple drug resistant gram neg bacteria
what is the 1st line tx for acute cystitis
- 5 days nitrofurantoin
- 3 days bactrim or trimethoprim
- single dose fosfomycin
what is the 2nd and 3rd line tx for acute cystitis
- augmentin, cefpodoxime, cefdinir, cephalexin for 5-7 days (2nd line)
- cipro or levo 3 days (3rd line)
if you are concerned about recurrent bacteria after tx of UTI what should you do?
repeat UA
what are urinary analgesics that can be used in acute cystitis
- phenazopyridine (azo) after meals for 2 days
- Methenamine
what is the MOA of Phenazopyridine (azo)
unknown
what are CI for Phenazopyridine (azo)
- renal insufficiency
- known allergy
what are SE for Phenazopyridine (azo)
- HA
- dizziness
- GI cramps
- discolored urine
rare:
- AKI
- hemolytic anemia
- methemoglobiinemia
what is a caveat for Phenazopyridine (Azo)
- not for chronic or long term use
- interferes with in-office UA dip
what is MOA of methenamine
Metabolizes into formaldehyde and ammonia in urine
Some formulations have additives to acidify the urine or provide pain relief
what are CI for methenamine
- renal or severe liver insufficiency
- allergy
- severe dehyration
- current tx with sulfanamides
what are DDI for methenamine
Sulfa drugs
what are SE for methenamine
- rash
- nausea
- dyspepsia
rare:
- elevated LFTs
what are supportive treatment additives for acute cystitis
- Sitz baths
- Increased PO fluid intake
- Cranberry juice or supplement
- Probiotics
- Vaginal estrogen
what are non pharmacollogical preventative measures for acute cystitis
what are pharmacologic preventative measures for acute cystitis
low dose abx QHS or PRN with coitus (sexual intercourse)
such as:
* bactrim
* trimethoprim
* nitrofurantoin
* cephalexin
* methenamine
when should pharmacologic preventative measures be considered
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!!
acute pyelonephritis is also known as
kidney infection
what is the etiology of acute pyelonephritis
- G- bacteria MC
- E. coli, klebsiella, proteus, pseudomonas
- G+ possible such as enterococci and staph
what is the epidemiology for acute pyelonephritis
MC in women but less common in general than acute cystitis
what are symptoms for acute pyelonephritis
- irrative voiding
- suprapubic pain
- +/- gross hematuria
- fever!!!!!!! (bolded in different color)
- chills (bolded)
- NVD (bolded)
- flank pain (bolded)
what would PE findings be for acute pyelonephritis
- fever
- tachycardia
- CVA tenderness (bolded and in different color)
what diabtes medications are likely to contribute to UTIs
SGLT2 inhibitors
what imaging modalities are preferred in Acute pyelonephritis
- not indicated in uncomplicated cases BUT if you do use:
- CT (preferred, shows inflammation and abscesses)
- US (shows hydronephrosis and maybe abscesses)
what are the lab findings in acute pyelonephritis
- 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.
what would indicate that a patient CAN be treated outpatient for acute pyelonephritis
- tolerates PO fluids and meds
- mild/mod s/s
- uncomplicated
- compliant with tx
for outpatient therapy in the treatment of acute pyelonephritis, what is the treatment regimen? (not the actual meds)
- oral abx +/- initial IV abx
what are oral abx options for acute pyelonephritis
- levo 5-7 days
- cipro 7 days
- bactrim 14 days
- augmentin 10-14 days (not first line, dont use tbh)
what abx CANNOT be used in tx for acute pyelonephritis
- nitrofurantoin
- oral fosfomycin
what are initial IV options for abx treatment in acute pyelonephritis
- ceftriaxone (rocephin) 1 dose
- cipro 1 dose
- gentamicin 1 dose
what is indication for inpatient therapy in acute pyelonephritis
- unable to do PO fluids/meds
- severe illness s/s
- complications (sepsis, obstruction)
- non compliance
for inpatient therapy in the treatment of acute pyelonephritis, what is the treatment regimen? (not the actual meds)
empiric tx based on risk of infection with MDR G- bacteria.
if there are no risk factors for MDR G- bacteria, what abx could you use to treat inpatient acute pyelonephritis
- IV ceftriaxone
- IV pip/taz
- IV amp/gent
- IV or oral flouroquinolones
if there are risks for MDR G+ bacteria, what abx could you use to treat inpatient acute pyelonephritis
add on one of the following:
- vanc
- linezolid
- daptomycin
if there are 1+ risk factors for MDR G- bacteria, what abx could you use to treat inpatient acute pyelonephritis
- Iv imipenem, meropenem, or doripenem
- high resistent - IV ceph + BL inhibitor
when can you switch inpatient acute pyelonephritis therapy to PO and how long will treatment last
May switch to PO as pt improves clinically and can tolerate PO intake - 14 d total tx
what are possible complications for acute pyelonephritis
- Sepsis/Septic shock
- Scarring and nephron loss
- Chronic pyelonephritis
- Major renal abscess formation
what is acute erethritis
inflammation of the urethra
what is the etiology of acute urethritis
- neisseria gonorrhoeae (MC)
- chlamydia tachomatis (2nd MC)
- mycoplasma genitalium (3rd MC)
- could also see trichomonas vaginalis
what are the 2 general classificiations of acute urethritis
- gonococcal urethritis
- non-gonococcal urethritis
what is the epidemiology of acute urethritis
MC in young, sexually active males.
what are symptoms of acute urethritis
- irritative voiding
- pain/pruritus at erethral meatus
- urethral discharge
what are PE findings for acute urethritis
- +/- inflammation at urethral meatus
- urethral discharge
(may have to “milk the urethra” for discharge, gross.)
what percentage of acute urethritis is asymptomatic
Up to 10% of gonococcal urethritis and 42% of NGU
what labs are present in acute urethritis
- > 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
what is the treatment for gonococcal acute urethritis
ceftriaxone (rocephin) 1 dose
what isthe tx for chlamydial acute urethritis
- azithromycin 1 dose
- doxy x 7 days (preferred)
either can be used but doxy preferred.
what is prophylactic treament for acute urethritis
all sexual partners must be treated and it must be reported to the health people.
yay! all done
:)
