UTI, Pyelo, and ABs Flashcards
Urethritis is often associated with?
STI
Culture and Senstivity does not…
pick up GC and Chlamydia in a timely fashion
What are some predisposing factors for UTIs?
use of spermicide (as with diaphragm for contraception)
frequent sexual intercourse
*20-30% will have recurrence
What pt is at a greater risk of UTIs?
diabetic women - 2-3x higher incidence
If a post-menopausal women has recurrent UTIs, what are her predisposing factors?
hx of premenopausal UTIs
anatomic factors affecting bladder emptying (cystoceles, urinary Incontinence, residual urine)
tissue effect of estrogen depletion
What are predisposing factors for UTI in men?
prostatic hypertrophy
non-circumcised
What is ABU?
Asymptomatic bacteriuria
urine sample is obtained for another reason & shows bacteria on microscopic evaluation
*generally do not treat unless sx develop
What qualifies an uncomplicated UTI?
- Non-pregnant female
- No anatomic abnormalities
- No instrumentation of the urinary tract
What qualifies a complicated UTI?
- ANY pregnant female since
- 2 patients
- can lead to premature labor
- low birth-weight babies
- Anatomic variant (ex. single kidney)
- Foreign body in the urinary tract
- Extrinsic compression of ureter/bladder
- Immune suppression conditions (diabetes)
What are the contributing factors for interstitial cystitis?
- Chronic bladder infection
- Inflammatory factors
- Unusual pain sensitivity
- Functional co-morbidities
What organisms are in the ddx for:
- Urethritis
- Vaginitis
- Cervicitis
- Gonorrhea, Chlamydia, Herpes
- Candida, Trichomonas
- Chlamydia, Neisseria
If urine dip and urine microscopic are negative, do you need a urine culture?
no - unless you’re thinking STI
What ABs are used for GC?
Ceftriaxone and Azithromycin
What ABs are used for chlamydia?
Azithromycin or doxycycline
How do you tx cystitis? pyelonephritis?
- Trimethoprim-Sulfamethoxazole
- Fluorquinolone–eg levofloxacin
What sx are seen with pyelonephritis?
- Generally sicker
- Fevers/chills
- Body aches (esp back pain)
- Typically ascending from lower tract infection
- Positive CVA tenderness
What are the most common precursors of pyelonephritis?
- Same as UTI (most commonly ascending from lower tract)
- Most common organism is E. Coli
- Can be hematogenous spread to kidney instead of ascending, but very rare
- Candida, Salmonella, Staph aureus
What are the three big complications of pyelonephritis?
- Papillary Necrosis
- Emphysematous pyelonephritis
- Xanthogranulomatous pyelonephritis
What is emphysematous pyelonephritis?
production of gas in nephric and perinephric area
*almost exclusively in diabetic pts
What happens in xanthogranulomatous pyelonephritis?
suppurative destruction of renal tissue
can lead to abscess formation
What is sepsis? what is septic shock?
- Suspected or documented infection and an acute increase in organ failure
- Dysregulated host response to infection
- Progressive organ dysfunction leading to marked increase in mortality
What are the signs of shock?
- fever or hypothermia
- tachycardia
- tachypnea
- hypotension (can be unresponsive to fluid resuscitation)
- circulating cytokines
- endothelial injury
- edema
- decreased oxygenation of tissues
- build up of lactic acid
What are preventative measurements for UTIs?
- AB therapy
- pee after sex
- wipe front to back
- shower > bath
- cranberry products
- vitamin C
- increased fluid intake
