UTI and prostatitis Flashcards
what is UTI or prostatitis?
infection in any part of the urinary system (kidney, urther, bladder, urethra)
What are examples of bladder infections?
lower UTI or cystitis
what are examples of kidney infections?
pyelonephritis, or upper UTI
Asymptomatic bacterimia
a significant amount of bacteria in urine without any signs and symptoms
uncomplicated UTI
lower tract (cystitis) that presents with dysuria, urgency, frequency, and suprapubic tenderness
complicated UTI
metabolic, functional, and structural abnormality that may involve both the upper and lower tracts. increased rate of treatment failure
What does catherization put u at risk fro?
cathertization in the last 48 hours puts you at risk for developing a UTI
what is pyelonephritis and what’s it due to?
inflammation of the renal parenchym, calcies, and pelvis
infection due to bacteremia
what is urosepsis due to?
reuslts from infection of extravasated urine or the obstruction of infected urine
HOw do we test for these conditons?
Via urinalysis
what tests does urinalysis include?
lots
how do we collect urinalalysi samples?
midstream catch
catheter (note on label)
what can we expect to see in a UTI urinalysis?
- bacteremia
- hematuria
- Nitrites ( presence of bacteria that convert nitrates to nitrites (ex: E.coli)
- Pyuria (WBC) indicative of inflammation (including infection)
- WBC casts - indicative of renal origin leukocytes
what does WBC on a gram stain mean?
indicative of infection
what do epithelial cells on a gram stain mean?
contamination
what are coliforms?
part of normal intestinal flora of humans and animals that can be isolated from a variety of environmental sources
what grousp can I isloate coliforms from?
escherichia
klebisella
enterobacter
serratia
citrobacter
- all are gram negative baccili
what is a coagulase test (coagulase negative staphyloccocus)
differentiate S.aurea from this group (S. epidermis, s.saprophyticus, s.hemolticus)
relatively low virulence but often resistant to antibiotics
when should we treat asymptomatic bacteremia?
-we don’t treat unless:
- pregnant
- before TURP or urological procedures where mucosal bleeding is anticipated
-bacteremia persists fro 48 hours after removing cathether
treatment of asymptomatic bacteriemia before and after invasive urological intervention
- aerobic gram-negative bacilli
- TMP-SMX for 3 days
treatment of asymptomatic bacteriemia pregnancy and why
- increased risk of pyelonitis, preterm labor and low infant birthweight
- aerobic gram-neg bacilli and coagulare-negative Staph
- amoxicillin, clavulanic, cephalexin, fosfomycin
- duration for 3- 7 days
what are some Symptoms of uncomplicated cystitis
- usual: dysuria, frequency, urgency, suprapubic pain
- delirium (elderly, rule out other causes)
- fever (uncommon, if present treat like pyelonephritis and get blood cultures_
usual pathogens for uncomplicated cystitis
e.coli and entererobacteriases
coagulase-negative staph
enterococcus
tx of uncomplicated cystsiis
first -line (problem with these is minimual tissue penetration)
- nitrofurantoin (5 days)
- fosfomycin (1 dose)
second-line
- TMP -SMX (3 days)
- Cipro (3days) ( this can cause lots of damge to flora of gut
pregnancy uncomplicated cystitis
avoid Tmx-SMX in the start and towards the end
- avoid nitrofurantoin near-term
- do not use cipro
- treat for 7 days
- cefixime for 7 days
Prphylaxis - when is it needed? what should we do befreo starting tx
when 3 or more episodes per year
pretreatment urine culture is recommended
prophylaxis related to coitus
TMP-SMX
Nitrofuratoin
- both PO pericoitus
prophylaxis unrelated to coitus
TMP - SMX ( 1 before bedtime, or 3 times a week for 6 months)
Trimethoprim (PO for 6 months)
complicated UTI
functional or anatomical abnormality ( obstructive uropathy, recent instrumentation, delayed/ impaired voiding, metabolic abnormality, immunocompromised)
- males
- S and s siislar to usual
- can include systemic (fever, increased LKC, decreased BP)
what increase risks of complicated UTI?
catheters
when should we treat complicated uti and why?
only if UTI symptoms or systemic infection
b/c there is potential for abx misuse
complicated uti afebrile, systemically well tx
cefixime, amox/clav, cipro, tmp-smx
complicated uti febrile, systemically unwell tx
ampicillin
- gentmicin and ceftriaxone
complicated uti hemodynamically unstable
pip/tazo
gentamicin
duration of theroay for complicated uti
7-14 days
what step dwon from IV to po should we consider
FQ or TMP-SMX
