UTI and Pyelonephritis

Question 1

Pregnancy and Infections

Answer 1

2-3% have UTIs, and even asymptomatic can turn into pyeloneph bc decreased ureteral persistalsis, physiologic hydroneph, and increased ureteral obstruction

Question 2

3 Etiologies of UTIs

Answer 2

Most common is G-: E. coli
Recurrent, also E. coli, but not as dominant
Indwelling catheters, Proteus which produces urease so staghorn stones

Question 3

P vs. S Fibriae

Answer 3

P attach to transitional cells if person has P blood group antigen
S attach to uroepithelial cells

Question 4

Definition for Pyuria

Answer 4

> 5 WBC/hpf

Question 5

Lab Criteria for UTI

Answer 5

Pyuria + 100,000 organisms in culture w/out symptoms or 1,000 with symptoms

Question 6

Dipstick Evaluation of Pyuria

Answer 6

Leukocyte esterase: LE: Picks up >10 WBC/hpf so can be - and still pyuria

Question 7

Dipstick Evaluation of Bacteria

Answer 7

Only picks up G-, also false neg in pts w/ limited oral nitrate intake

Question 8

Sterile Pyuria

Answer 8

Atypical Organisms like Chlamydia, mycloplasma, TB

Question 9

Tx for Uncomplicated Cystitis

Answer 9

3 days tx sufficient w/ Bactrim, maybe quinolones if resistant (but not 1st line)

Question 10

Asymptomatic Bacteriuria

Answer 10

Maybe don’t have to treat but ALWAYS TREAT IN PREGNANT PATIENTS

Question 11

2 Things to Avoid in Pregnant Tx

Answer 11

Sulfonamides near term can cause kernicterus

Quinolones damage cartilage

Question 12

Complicated UTI

Answer 12

Always complicated in men

In women, when recurrent or secondary to other stuff

Question 13

Recurrent UTI Definition

Answer 13

> 3 in 1 year or >2 in 6 months. Need workup

Question 14

Acute Bacterial Prostatitis (4)

Answer 14

Most common cause of UTI in men
Elevated PSA common
Perineal pain
4-6 week course of Fluoroquinolones

Question 15

Cranberry UTI Prophylaxis

Answer 15

Contains tannins which reduce adherence of bacterial fibriae

Question 16

Pyelonephritis (2 things indicative of, as opposed to cystitis))

Answer 16

White Blood Cell cast

15-20% positive blood cultures

Question 17

Emphysematous Pyelonephritis

Answer 17

Characterized by gas accumulation from glucose fermenting bacteria. Usually in diabetics, pretty much no tx besides nephrectomy and life threatening