UTI Flashcards

1
Q

How to distinguish UTI?

A

We distinguish between ​simple​ and c​omplicated​. lower involves bladder only, upper means it’s climbing up the urinary tract (->pyelonephritis).

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2
Q

Prevalence

A

More common in women than men, due to shorter urethra-> easier access for microbes from fecal flora.

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3
Q

What are risk factors?

A

Anything that obstructs the urinary tract is an additional risk factor, e.g. kidney stones, BPH.

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4
Q

Sx of simple cystitis

A

D​ysuria​(pain), p​ollakiuria(​frequency), urinary urgency​ and suprapubic pain.
Generally, a patient with cystitis is not very sick. ​If they’re in bad shape, be careful with diagnosing simple cystitis.

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5
Q

dx cystitis

A

Diagnose with a urine dipstick test, will tend to be positive for ​leukocytes (leukocyte esterase), nitrite,​ and sometimes b​lood and protein.​ Leukocytes and nitrite absent on a dipstick test suggests it’s not cystitis.

Remember that a dipstick test should be done on ​midstream​urine. You want to see what’s in the bladder, not the urethra.

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6
Q

Treating cystitis

A

PO empiric antibiotics initially. ​Guidelines depend on country, but some common ones are ​nitrofurantoin (​OTC in Poland!), ​TMP-SMX ​and pivmecillinam.

If empiric treatment doesn’t work, a more precise diagnosis (i.e. culture) is in order.

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7
Q

What is upper UTI?

A

Occurs when the causative organism climbs higher up the urinary tract, reaching the
ureters or the kidneys, causing ​pyelonephritis.​

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8
Q

What cause upper UTI?

A

Common organisms are E​ .coli ​(most common), Klebsiella, Proteus,
Pseudomonas (​most common in hospital setting), Candida, etc.

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9
Q

sx of upper UTI

A

typical cystitis symptoms + signs of a more severe infection. These include
fever, chills, costovertebral angle tenderness, and flank pain. I​n men, you may also see​pelvic or perineal pain​, which may indicate prostatitis. Again, these patients often appear more sick in general.

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10
Q

dx of complicated/upper uti

A

Unlike simple cystitis, ​a complicated UTI warrants urine culture and ABx susceptibility testing.

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11
Q

tx of complicated/upper uti

A

Empiric ABx, but different drugs, and typically via IV. D​epends on risk factors for multidrug-resistant organisms. ​(Proven with culture, inpatient stay at hospital/nursing home/etc., recent use of other antibiotics, travel to parts of the world with high rates of multidrug resistant organisms)
■ No risk factors: C​eftriaxone ​or p​iperacillin-tazobactam​.
■ >0 riskfactors:​ penems.​Imepenem, meropenem, doripenem.

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12
Q

What is asymptomatic bacteriuria?

A

presence of greater than 10^5 colony forming units (CFUs) of bacteria per milliliter of urine

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13
Q

When is screening for asymptomatic bacteriuria recommended?

A

In 1st trimester of pregnancy

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14
Q

What is uncomplicated UTI?

A

Inf confined to the urinary bladder, usually in women

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15
Q

What is complicated UTI?

A

Presence of predisposing anatomic, functional abnormalities

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16
Q

What is negative predictive value of grossly clear urine?

A

91%

17
Q

What is the sensitivity for LE in dipstick?

A

70-90% for UTI

18
Q

When should you take culture?

A

If complicated or recurrent uncomplicated

19
Q

What make a false positive culture?

A

If sample is left in room temp bacteria multiply rapidly

20
Q

When is ABs indicated in asymptomatic becteriuria?

A
  1. during pregnancy
  2. young child w VUR
  3. pat w urologic problems / urethral obstruction
  4. renal transplant recipients during early post op
  5. pat w severe granulocytopenia
21
Q

When is it not recommended, and may be harmful to treat asymptomatic bacteriuria?

A

In elderly pat ( esp women)

22
Q

What should you do w resistant microorganism?

A
  • record the presence of microorganism

- prescribe ABs when and if pat develop any combo of fever, flank tenderness or documented bacteriuria

23
Q

Is pyuria in pat w asymptomatic bacteriuria indication for ABs?

A

no!