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835 > UTI > Flashcards

UTI Flashcards

1
Q

UTI Predisposing Factors

A
  • Obstruction: BPH, urethral structure, tumors, calculi, bladder diverticula
  • Incomplete emptying: SCI, DM, stroke, neuropathies
  • Reflux: over-distension, congenital, vesicoureteral reflux
  • Intercourse: diaphragms, spermicides
  • Urinary catheterization
  • Pregnancy
  • Previous UTI
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2
Q

Host Defense

A
  • Normal urinary tract: urine pH, osmolality, high [urea/organic acid], and prostate secretion
  • Stimulation of micturition by bacteria
  • Anti-adherence: Mucopolysaccharide, Tamm-Horsfall protein, immunoglobulins
  • Inflammatory response
  • Vaginal flora, estrogen
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3
Q

Common Pathogens

A
  • E. Coli
  • K. pneumoniae
  • Proteus spp
  • P. aeruginosa
  • S. saprophyticus
  • Enterococcus spp.
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4
Q

Virulence Factors

A
  • Organism’s degree of pathogenicity
  • Adhesion mechanisms like fimbriae
  • Hemolysin: ruptures RBCs
  • Aerobactin allow organism to absorb iron
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5
Q

Fimbriae

A
  • Hair like structure allowing binding to cell wall

- Mannose resistant, P-fimbriae binds to uroepithelial cells and is more likely to cause kidney stones

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6
Q

Routes of Infection

A
  • Hematogenous: uncommon, bacteria carried elsewhere in the body through the blood and seeds infection
  • Ascending: common, colonization of urethra with fecal flora leading to infection
  • Lymphatic: unknown incidence, limited amount of data
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7
Q

Diagnosis

A
  • Based on presence of symptoms and supported by urinalysis or urine culture
  • Asymptomatic UTI: presence of bacteria without symptoms
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8
Q

Cystitis UTI symptoms

A
  • Lower UTI
  • Dysuria
  • Urgency
  • Frequency
  • Suprapubic tenderness
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9
Q

Pyelonephritis UTI Symptoms

A
  • Upper UTI
  • Flank pain
  • Fever
  • Nausea
  • Vomiting
  • Malaise
  • CVA tenderness
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10
Q

Catheter Associated UTI Symptoms

A
  • Compatible with UTI + urethral/suprapubic/intermittent catheterization
  • > 10^2 cfu/mL of bacteria in fresh catheter urine culture
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11
Q

Clean Catch

A
  • Preferred urine specimen collection method
  • Least invasive
  • Discard first 20-30 mL voided
  • Requires clean urethral opening
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12
Q

Alternative Urine Collection

A
  • Catheterization: for uncooperative or unable to void patients
  • Suprapubic bladder aspiration: used in newborns, infants, paraplegics, and seriously ill patients when other methods have failed
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13
Q

Urinalysis

A
  • Nitrates: present when bacteria reduces urinary nitrates
  • LCE: produced by neutrophils
  • Squamous cells: >= 20 then sample likely contaminated
  • WBCs: shows GU inflammation and if >= 10 then may indicate a UTI
  • Bacteria/yeast: could be normal flora, contaminant, or sign of UTI
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14
Q

Urine Culture

A
  • Most reliable way to diagnose UTI

- Quantity of colony forming units to confirm infection: >= 10^5 of single strain

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15
Q

Cranberry

A
  • No conclusive data that it prevents UTI

- Potential benefit may be more related to hydration vs cranberry itself

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16
Q

Asymptomatic Bacteria

A
  • Only treat if pregnant or with pending GU procedure

- Options: Macrobid, Augmentin, Cephalexin, Fosfomycin, or Bactrim

17
Q

Asymptomatic Bacteria + Drug Doses

A
  • Macrobid: 100 mg PO BID x 5-7 days (don’t use if at term, 1st trimester, or pyelonephritis)
  • Augmentin: 875/125 mg PO BID x 5-7 days
  • Cephalexin: 500 mg PO BID x 5-7 days
  • Fosfomycin: 3g PO as single dose (don’t use if pyelonephritis suspected)
  • Bactrim 1 DS PO BID x 3-7 days (avoid in 1st or late 3rd trimester)
18
Q

Uncomplicated Cystitis

A
  • Don’t need initial urine culture

- Health women: 12-45 y.o., premenopausal, not preggo, no structural abnormalities

19
Q

Uncomplicated Cystitis Treatments

A
  • Macrobid: 100 mg PO BID x 5 days
  • Bactrim: 1 DS tablets PO BID x 3 days
  • Fosfomycin: 3g powder PO x 1 dose
  • Augmentin: 500/125 mg PO TID x 5 days
  • Cefdinir: 300 mg PO BID x 5 days
  • Cefpodoxime: 100 mg PO BID x 5 days
  • Ciprofloxacin: 250 mg PO BID x 3 days
  • Levofloxacin: 250 mg PO q24h x4days
20
Q

What NOT to use empirically for Uncomplicated Cystitis

A
  • Amoxicillin

- Ampicillin

21
Q

Complicated Cystitis

A
  • All adults who don’t meet uncomplicated criteria
  • Usually from structural abnormality
  • Treatment depends on severity, is the same as pyelonephritis
  • Duration: 7-10 days
22
Q

Mild-Mod. Pyelonephritis

A
  • Fever and CVA tenderness
  • May treat with oral regimens and outpatient
  • Obtain UA, urine, and blood cultures
23
Q

Mild-Mod. Pyelonephritis Treatments

A
  • Cipro: 500 mg PO BID x 7 days
  • Levofloxacin: 500 mg PO daily x 7 days
  • Bactrim: 1 DS PO BID x 3 days
  • Augmentin: 875/125 mg PO BID x 10-14 days
  • Cephalexin: 500 mg PO QID x 10-14 days
  • Ceftriaxone: 1-2g IV daily
24
Q

Severe Pyelonephritis

A
  • Fever > 38.3 C
  • Severe flank pain
  • N/V, dehydration, hemodynamic instability, sepsis
  • Treat inpatient with IV
  • Obtain UA, urine, and blood cultures
  • Can switch to PO once afebrile x 24-48 hours
  • Duration: 10-14 days
  • Repeat cultures should be considered after treatment to ensure resolution of infection
  • Adjust treatment based on culture results
25
Q

Severe Pyelonephritis Parenteral Treatment

A
  • Zosyn: 4.5g IV q6h
  • Cipro: 400 mg IV q12h
  • Levofloxacin: 500 mg IV q24h
  • Ceftriaxone: 1g IV q24h
  • Cefepime: 2g IV q8h
26
Q

Severe Pyelonephritis Oral Treatment

A
  • Cipro: 500 mg PO BID
  • Levofloxacin: 500 mg PO daily
  • Bactrim: 1 DS PO BID
27
Q

CAUTI

A
  • Catheter-Associated UTI
  • Plastic tubing promotes bacteria growth and formation of biofilms
  • Urine samples from old catheters won’t give accurate cultures
  • Change catheter every 2 weeks
  • Treat based on pathogens/susceptibilities
  • Duration: 7 days if prompt resolution of symptoms or 10-14 days for delayed response
28
Q

Adjuvant Therapy

A
  • Phenazopyridine HCl
  • OTC: anesthetic and analgesic to relieve symptoms
  • 100-200 mg TID after meals x 2 days + APPROPRIATE ABX
  • Secretions may change to a red-orange and permanently stain clothing
29
Q

Relapse

A
  • Same organism within 2 weeks after completion
  • Obtain sample and culture for susceptibility
  • Evaluate resistance, adherence, and other sources
30
Q

Recurrence

A
  • > 2 weeks after treatment or after documented sterile culture
  • Defined as >= 2 UTIs within 6 months or >= 3 UTIs in a year

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