UTI - Brown Flashcards
How many colonies on a culture indicate the presence of a UTI (microbiology definition)?
How many colonies in a symptomatic patient before you start treatment?
100,000 org/ml (microbiology definition) In patients with symptoms: 100-10,000 to begin treatment multiple organism (3+) suggests contamination
Microbiology definition of UTI
100,000 org/ml.
Symptomatic: 100-10,000
Multiple organisms (3 or more) suggest contamination
Risk Factors for UTIs (8)
1) Gender
2) Sexual activity and contraception
3) Pregnancy
4) Obstruction
5) Neurogenic bladder dysfunction
6) Vesicoureteral reflux
7) Bacterial virulence factors
8) Immunosuppressed states: Sickle cell
Clinical symptoms of UTI:
Dysuria
Frequency
Urgency
Suprapubic pain/pressure
With complaints of vaginal discharge, the dx of a UTI Increases/ Decreases by 20%
Decreases- vaginal symptoms may be causing dysuria
Who needs a urine C&S?
1) Seriously ill pts
2) Recently hospitalized/ hospitalized pts
3) Men and all children
4) Women with relapse or reinfection
5) Women with complicating factors
6) Pregnancy
Etiology of UTI in women
1) E. coli (75-95%)
2) Enterobacter
3) Klebsiella
4) Proteus
- Gram negative causes 90-95%
- Gram + cause 5-10%
- Staph saprophyticus cause 10-15%
What drug for UTIs could you use for prophylaxis
Trimethoprim: Bacteriostatic
Drug of choice for UTI
Trimethoprim-Sulfamethoxazole
What is a drug for UTIs active against G+ and G- bugs which is contraindicated in pts with GFR <60 but safe in early pregnancy
Nitrofurantoin
What can you use for UTIs but is not first line?
Cephalosporins, FQ (resistance, contraindicated in kids and pregnancy)
What is first line in UTI is resistance to TMP/SMX is >20%
Quinolone
Fosfomycin is only indicated in what type of UTI
Uncomplicated UTI
For symptomatic UTIs, normally how long do you treat?
3 days
Urinary analgesics:
1) Phenazopyridine (Pyridium) - turns urine orange, stains
2) Flavoxate (Uripas)
3) Cranberry Juice?
Safe drugs for UTIs in pregnancy:
1) Penicillins
2) Cephalosporins
3) Nitrofurantoin
4) Fosfomycin
T/F: If a pregnant women is suspected of having pyelonephritis, what should you do?
Hospitalize
Treatment for Pyelo outpatient
1) FQ or TMP-SMZ recommended
2) Amox or Augmentin ok if gram + bug
- 10-14 days
DDX for Dysuria
1) Cystitis
2) Painful Bladder Syndrome
3) Vaginitis (Infectious, Chemical, PID)
4) Prostatitis
5) Urethritis
6) Meatal strictures
T/F A UTI in a male patient is very rare and possibly pathologic and should undergo a work-up.
TRUE
UTI’s are very common in females.
Protective Factors
Long urethra Bladder emptying Antibacterial properties of urine Prostatic secretions PMNs in bladder wall
UTI Urinalysis Findings
Cloudy urine Malodorous Hematuria (microscopic) Dipstick Results: nitrite (+) or leukocyte esterase (+) Microscopic: WBC, Bacteria, casts
UTI Physical Findings
Vitals - document temperature
Suprapubic Palpation
Palpation of CVA
Lab - get a urine sample
__________ is the most common etiologic agent of UTI’s and what what is the drug of choice.
E. Coli
Trimethoprim-Sulfamethoxazole (TMP-SMZ)
3 Drugs of Choice for Uncomplicated UTIs
Nitrofurantoin
TMP/SMX (depends on local resistance rates)
Fosfomycin
Helpful Suggestions for Patients with UTIs
Drink plenty of water
Void frequently
Void after intercourse
What is definition of recurrent UTI’s?
What can be used for prophylaxis?
3 documented UTIs/year
Prophylactic: Nitrofurantoin, Keflex, TMP-SMZ, Noroxin
Most Common Etiology for Pyelonephritis
E. coli Proteus Klebsiella Enterobacter Psuedomonas
Clinical Findings in Pyelonephritis
Fever
Flank Pain
Shaking Chills
Voiding Symptoms: dysuria, frequency
Constitutional Symptoms: nausea, vomiting, diarrhea
Physical Exam: fever, tachycardia, +/- CVA tenderness
What finding on microscopic urinalysis is a strong indicator of pyelonephritis?
WBC casts
UTI Symptoms in Newborns and Infants
non-specific signs: fever, poor feeding, irritability, vomiting, sepsis, hypothermia
strong, foul-smelling odor
UTI Symptoms in Preschool
abdominal or flank pain, vomiting, fever, frequency, dysuria, enuresis
UTI Symptoms in School-Age Children
classic signs and symptoms but CVA tenderness is uncommon
