UTI Flashcards
How to distinguish UTI?
We distinguish between simple and complicated. lower involves bladder only, upper means it’s climbing up the urinary tract (->pyelonephritis).
Prevalence
More common in women than men, due to shorter urethra-> easier access for microbes from fecal flora.
What are risk factors?
Anything that obstructs the urinary tract is an additional risk factor, e.g. kidney stones, BPH.
Sx of simple cystitis
Dysuria(pain), pollakiuria(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.
dx cystitis
Diagnose with a urine dipstick test, will tend to be positive for leukocytes (leukocyte esterase), nitrite, and sometimes blood and protein. Leukocytes and nitrite absent on a dipstick test suggests it’s not cystitis.
Remember that a dipstick test should be done on midstreamurine. You want to see what’s in the bladder, not the urethra.
Treating cystitis
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.
What is upper UTI?
Occurs when the causative organism climbs higher up the urinary tract, reaching the
ureters or the kidneys, causing pyelonephritis.
What cause upper UTI?
Common organisms are E .coli (most common), Klebsiella, Proteus,
Pseudomonas (most common in hospital setting), Candida, etc.
sx of upper UTI
typical cystitis symptoms + signs of a more severe infection. These include
fever, chills, costovertebral angle tenderness, and flank pain. In men, you may also seepelvic or perineal pain, which may indicate prostatitis. Again, these patients often appear more sick in general.
dx of complicated/upper uti
Unlike simple cystitis, a complicated UTI warrants urine culture and ABx susceptibility testing.
tx of complicated/upper uti
Empiric ABx, but different drugs, and typically via IV. Depends 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: Ceftriaxone or piperacillin-tazobactam.
■ >0 riskfactors: penems.Imepenem, meropenem, doripenem.
What is asymptomatic bacteriuria?
presence of greater than 10^5 colony forming units (CFUs) of bacteria per milliliter of urine
When is screening for asymptomatic bacteriuria recommended?
In 1st trimester of pregnancy
What is uncomplicated UTI?
Inf confined to the urinary bladder, usually in women
What is complicated UTI?
Presence of predisposing anatomic, functional abnormalities
What is negative predictive value of grossly clear urine?
91%
What is the sensitivity for LE in dipstick?
70-90% for UTI
When should you take culture?
If complicated or recurrent uncomplicated
What make a false positive culture?
If sample is left in room temp bacteria multiply rapidly
When is ABs indicated in asymptomatic becteriuria?
- during pregnancy
- young child w VUR
- pat w urologic problems / urethral obstruction
- renal transplant recipients during early post op
- pat w severe granulocytopenia
When is it not recommended, and may be harmful to treat asymptomatic bacteriuria?
In elderly pat ( esp women)
What should you do w resistant microorganism?
- record the presence of microorganism
- prescribe ABs when and if pat develop any combo of fever, flank tenderness or documented bacteriuria
Is pyuria in pat w asymptomatic bacteriuria indication for ABs?
no!
