UTI Flashcards
UTI risk factors
aging, females, males (prostatic hypertrophy, bacterial prostatitis, anal intercourse), urinary tract obstruction (tumor, calculi), impaired bladder innervation
Lower tract infection
urethritis, prostatitis, cystitis
Upper tract infection
pyelonephritis, peri nephric abscess
Trigone
- smooth triangular region of the internal urinary bladder formed by the two uretral orifices and the internal urethral orifice
- sensitive to expansion and when stretched to certain degree signals the brain it needs to empty
Symptoms of UTI
- dysuria
- increased frequency
- hematuria
- fever (systemic)
- N/V (pyelonephritis)
- flank pain (pyelonephritis)
- pain with defecation
CVA tenderness
pyelonephritis
Urethral discharge
urethritis
Tender prostate on DRE
prostatitis
Labs (urinalysis)
+ leukocytes
+ nitrites (gram neg rods)
+ WBC
+ RBC
Most valuable LAB diagnostic test for UTI
UA for pyuria
- presence of pyuria makes the dDx
Most common pathogens
E. coli (80%) ; Staphylococcus saprophyticus (15%)
Positive Urine Culture
Bacterial colony >10 (2) CFU/ml (symptomatic pt) or 10 (5) CFU/ml (Asymptomatic) + leukocytes
Uncomplicated (Simple) Cystits
+ Dysuria - non- pregnant
+ Lower abd cramping - Healthy (> 12 y.o)
+ frequency - No N/V, flank pain
+ urgency
How do you diagnose simple cystitis
Dipstick Urinalysis
What is present in almost all pts with complicated UTI?
Pyuria
What does white cell casts suggest?
Renal origin for pyuria
Treatment for Uncomplicated (Simple) Cystitis
- Trimethroprim/Sulfamethoxazole for 3 DAYS
- TMP-SMX double strength 1 tab BID
- Given for 7-14 days in men
- May use fluoroquinolone (Ciprofloxacin/Levaquin) with sulfa allergies or areas of high bactrim resistance
Risk fx for Uncomplicated Cystitis
Sexual Intercourse: may recommend post-coital voiding or prophylactic ABT use
Definition of Complicated Cystitis
- female with comorbid medical conditions
- ALL MALE PATIENTS
- Indwelling foley cath
- Urosepsis/hospitalization
How do you diagnose Complicated Cystitis?
UA/C&S
Tx for Complicated Cystitis
- Fluoroquinolone (or another broad spectrum)
- 7-14 days tx
- May treat longer (2-4 weeks) in males with UTI
Pyelonephritis (S/S)
fever, N/V, headache
Pyelonephritis (Diagnosis)
UA, C&S, CBC, Chemistry
Pyelonephritis (Treatment)
- 2 weeks of Bactrim or Fluoroquinolone
- Hospitalization and IV ABT if pt unable to take PO
Perinephric / Renal Abscess
- suspect in pt who is not improving on ABT therapy
- Dx: CT with contrast, renal ultrasound, may need surgical drain
Treatment of Pyelonephritis (Mild to Moderate)
- Ceftriaxone 1 g q 24 h
- Cipro 400mg q 12 h
- Levofloxacin 750mg q 24 h
- Aztreonam 1 g q 8 to 12 h
Treatment of Pyelonephritis (Severe)
- Cefepime 2 g q 12 h
- Piperacillin-tazobactam 3.375g q 6 h
- Ceftolozpne-tazobactam 1.5g q 8 h
- Ceftazidime-avibactam 2.5g q 8 h
- Meropenem 500mg q 8 h
- Imipenem 500mg q 6 h
- Doripenem 500mg q 8 h
Prostatitis (S/S)
pain in perimeum, lower abd, testicles, penis, and with ejaculation, bladder irritation, bladder outlet obstruction, sometimes blood in semen
Prostatitis (Diagnosis)
- Clinical Hx: fever, chills, dysuria, malaise, myalgia, pelvic/perineal pain, cloudy urine
- edematous and tender prostate on exam
- Increased PSA
- UA/C&S
Prostatitis (Treatment)
Bactrim, fluoroquinolone, or other broad spectrum ABT for 4-6 WEEKS
Urethritis (Chlamydia trachomatis)
- frequently asymptomatic in females
- dysuria, discharge or PID
- pyuria, (-) bacteria = suspect chlamydia
- Chlamydia screening for females less than or equal to 25 yr
- Tx: Azithromycin 1 g po x 1; Doxycycline 100mg po BID x 7 days
Urethritis (Neisseria Gonorrhoeae)
- may present with dysuria, discharge, PID
- Tx: Ceftriaxone 125mg IM x 1; Cipro 500mg x 1; Levofloxacin 250mg po x1; Ofloxacin 400mg po x 1, Spectinomycin 2g IM x 1
