UTI Flashcards
complicated UTI
pregnant, abnormal urological anatomy, diabetes, immunocompromised, indwelling bladder catheter, male.
any one of these
epidemiology of UTI
most common bacterial infection in outpatient setting.
by 32 half of women had at least one UTI (cystitis)
pathogenesis
UT is sterile 95% of the time.
e. Coli (most common)
proteus mirabilis
klebsiella pneumoniae
well defined risk factors
sexual intercourse, new partner, spermicides, recent UTI
less defined risk factors
voiding patterns, voiding frequency, 24hr fluid intake, wiping patterns, BMI
pathogenesis
GI pathogens colonize peri-urethral mucosa,
ascend through urethra to bladder
continue on to ureters/kidney. (UUTI)
uropathogenic e. Coli
pili, flagella, adhesins, siderophores, toxins, polysaccharide coating.
suggestive cystitis
pain or burning urination
increased frequency
increased urgency
suprapubic pain
pyelonephritis
fever >38.3
flank or costo-vertebral angle pain
nausea/vomiting
+/- symptoms of cystitis
lab diagnosis
gold standard: symptoms + culture demonstrating >10^5 colony-forming units
AND evidence of inflammation.
asymptomatic bacteriuria
positive urine culture without inflammation
specific gravity
urine density/density of water
nitrite
metabolic byproduct of some uropathogenic bacteria
WBC screen
should be less than 5 per high power field.
urinalysis in isolation
not diagnostic
most common treatment
notrofurantoin, TMP/SMX, fosfomycin
even though it usually resolves without antibiotics. these are used to provide symptom relief.
drug resistance
amoxicilin is >20%
recurrent UTI
failure of antibiotic- reculture, change AB
incorrect diagnosis- re-eval symptoms
behavioral/ biological cause- change behavior
asymptomatic bacteriuria
positiv urine culture without symptmos of UTI or inflammation.
no need for ab unless:
pregnant, pre-urology procedure, renal transplant, neutropenic
catheter associated UTI symptoms
usually lack typical UTI symptoms
new fever with no other source
CVA tenderness, flank pain, pelvic discomfort.
catheter associated UTI diagnosis
inflammation doesnt necessarily correlate
absence of pyuria rules it out!!!
catheter associated UTI treatment
remove catheter, replace if indicated.
ABs last longer. 7 days if prompt, 10-14 if delayed.
3 days if catheter removed in female without evidence of associate pyelo
