UTI lecture Flashcards
Acute cystitis
Acute pyelonephritis
Uncomplicated UTIs
UTIs in: pregnancy elderly children males catheter pts
Complicated UTIs
most common GU complaint
UTI
female to male ratio for pyelonephritis
30:1
Obstruction
Anatomic abnormality
Urologic dysfunction
Multi drug resistant uropathogen
Condition that may cause complicated UTI
Females Sexual intercourse (recent or frequent) Diaphragm use Spermicide use Hx of UTI Delayed post-coital micturation
UTI Risk factors
develops when pathogens ascend to the kidneys via ureters
Pyelonephritis
_______ accounts for 75-95% of uncomplicated UTIs
E. Coli
Dysuria (or "burning") increased urinary frequency increased urinary urgency suprapubic pain/discomfort \+/- hematuria voiding in small amounts **AFEBRILE
Acute Cystitis
\+/- cystitis signs PLUS FEVER* chills flank pain costovertebral angle tenderness N/V
Acute pyelonephritis
what MUST you think about if you have blood in urine without discomfort
urine cancer
Pyuria
Bacteriuria
Varying degrees of hematuria
+ Leukocyte esterase (an enzyme released by leukocytes)
+ Nitrites (reflecting presence of bacteria which convert urinary nitrate to nitrite)
White cell casts – diagnostic for upper tract infx
Urinalysis in UTI
Urine culture with more than 100,000 bacteria cfu/mL
UTI
Hematuira
Leukocytes
Nitrites
WBCs
Can be seen in urinalysis of pt with UTI
- TMP-SMX DS
- Nitrofurantoin
- Fosfomycin
First line agents for uncomplicated cystitis in women
Bacteria convert urinary nitrate into…
nitrite
Ciprofloxacin in acute cystitis
alternative agent for acute cystitis
Pyridium in UTIs is used for…
pain! numbs bladder
**NO LONGER THAN 2 DAYS!!!
Why should you not use Pyridium in UTIs for longer than 2 days?
Masks symptoms..should be starting to feel better after on antibiotics for 2 days
Pyelonephritis with:
Mild to moderate illness
Stabilized with rehydration
treat with…
Outpatient oral antibiotics
Pyelonephritis with.. Severe illness High fever, pain Marked debility Inability to maintain oral hydration or take PO rx Pregnancy Concerns about compliance
treat with…
Inpatient IV antibitoics
DOC for outpatient acute pyelonephritis
Ciprofloxacin
FQ or AMP+gentamicin or ceftriaxone
IV acute pyelo tx
UTIs usually respond to tx within….
48-72 hours
Wipe from front to back Increase fluid intake Cranberry juice Void often Avoid irritants Change birth control method
UTI prevention
Elderly Pregnant Children Men CAUTI
Special population UTIs
Bladder and/or uterine prolapse
Loss of estrogen causing change in vaginal flora
Loss of lactobacilli in vaginal flora which results in periurethral colonization of E.coli
Concomitant medical illnesses (i.e., diabetes)
causes of UTIs in postmenopausal women
Benign prostatic hypertrophy can cause
UTIs in men
asymptomatic bacteriuria
can be seen in pregnancy
Up to 40% risk of developing UTI, including pyelonephritis, during pregnancy
Associated with preterm birth, low birth weight & perinatal mortality
Present in 4-7% of pregnancies
Screen in 1st trimester with UC
If UC positive, treat and then repeat q trimester
Tx nitrofurantoin x 7 days
Suppressive therapy after 2 or more courses antibx
asymptomatic bacteriuria
Most common pathogen that causes UTIs in children
E coli
Most common cause of nosocomial infections in US
CAUTIs
advanced age, underlying illness & duration of catheterization
risk factors for CAUTIs
screen urine how many hours after removing catheter?
48 hours
asymptotic CAUTIs….
do NOT require antibiotics
3 or more episodes per year (confirmed by UC) or 2 UTIs in last 6 months
recurrent UTIs
vaginal estrogen in postmenopausal women
can help prevent UTIs
Isolation of a single organism on UC from an individual without s/s of UTI
- *Women – at least 2 occasions of 100,000 CFU/ml
- *Men – at least 1 occasion of 100,000 CFU/ml
Asymptomatic bacteriuria
Do you treat asymptomatic bacteriuria in:
- Pregnant women
- Prior to urologic procedures
- After renal transplantation
YES
What type of technique used to collect urine specimen?
Clean catch
Diagnosis of ________ is often based on patient’s history alone (96% probability) in women presenting in outpatient setting with triad and no vaginal discharge
acute cystitis
Should Pyridium be used as initial therapy?
NO!
