UTI, pyelo, IC Flashcards
What pathogen accounts for 75-95% of cases of UTI
Escherichia coli
What are the other pathogens of UTI
- gram negative
- Klebsiella
- Proteus
- Pseudomonas aeruginosa
- gram positive
- staph saprophyticus
- enterococcus
Differentiate between upper and lower tract infections
- upper tract
- Pyelonephritis
- lower tract
- Cystitis
- urethritis
- prostatitis
Name the risk factors for UTI
- reduced urine flow
- promote colonization
- facilitate ascent
what are some causes of reduced urine flow that makes a person at risk for UTI
- outflow obstruction
- inadequate fluid intake
- neurogenic bladder
what are some causes of things that promote colonization that makes a person at risk for UTI
- sexual activit, spermicide use
- estrogen depletion
- recent antimicrobial use
what are some things that facilitate ascent that makes a person at risk for UTI
- catheterization
- urinary incontinence
Name the characteristics that make a UTI uncomplicated
- immunocompetent
- no comorbidies
- no known urologic abnormalities
- not pregnant
- premonopausal
what is cystitis
infection of the bladder
acute cystitis has what 3 characteristic symptoms
- dysuria
- frequency
- urgency
- can also have hematuria and/or suprapubic discomfort
probability of cystitis increases in women who have dysuria and frequency without
vaginal discharge/irritation
what parameter on urine dipstick is most specific for UTI
+ leukocyte esterase
nitrite can have a false positive with what medications
- phenazopyridine (Azo, pyridium)
when are urine cultures recommended
- suspect complicated infection
- suspect acute pyelonephritis
- symptoms that do not resolve
- symptoms that recur
- atypical presentation
what number of colony-forming units per mL is diagnostic for acute cystitis
- > or = 103
- 102 is + is women with typical symptoms
what should be given in addition to antimicrobial therapy for UTI
- Phenazopyridine (Pyridium) 200 mg TID x 2 days
What is the first line treatment options for acute, uncomplicated cystitis in women
- Timethoprim/Sulfamethozazole (Bactrim) 160/800 mg BID x 3 days
- Nitrofurantoin (Macrobid)
- Fosfomycin (Monurol): single dose
why would you not give bactrim for acute, uncomplicated cystitis in women
- prevalence of resistant > 20%
- used for UTI in previous 3 months
What is the second line treatment options for acute, uncomplicated cystitis in women
-
Fluoroquinolones
- Ciprofloxacin
- Cipro XR
- Levofloxacin
- Ofloxacin
What is the third line treatment options for acute, uncomplicated cystitis in women
- oral beta-lactams
What is the first line treatment options for acute, complicated cystitis in nonpregnant women
- Fluoroquinolones
What is the first line treatment options for acute, uncomplicated cystitis in men
- bactrim or
- fluoroquinolones
What is the first line treatment options for acute cystitis in pregnant women
- Macrobid
- Augmentin
- ***Avoid fluoroquinolones!!!!!
patient education for acute cystitis
- push fluids
- void when feel urgency
- void before and after sexual intercourse
- complete course of Abx
- signs of pyelonephritis
What is pyelonephritis? what conditions can it lead to
infection of the kidney
- can lead to
- renal abcess
- sepsis
- shock
- ARF
These UA results are consistent with
- pyuria (> 10 leukocytes/micoL)
- bacteriuria
- +/- hematuria
- white blood cell casts
pyelonephritis
When is imaging indicated in acute pyelonephritis? what imaging is indicated
- complicated pyelonephritis or
- appear severely ill
- CT +/- contrast
Tx for mild-moderate acute pyelonephritis (outpatient management)
- Fluoroquinolones x 1 week
- if local resistance in Ecoli > 10 %
- add Ceftriaxone (rocephin)
- Must f/u in 24-48 hours
What are the indications to admit a patient with acute pyelonephritis
- concerns about compliance
- comorbid conditions
- hemodynamic instability
- male
- metabolic derangement (acidosis)
- pregnancy
- severe pain
- toxic appearance
- unable to take liquids by mouth
- very high fever (>103 F)
inpatient tx for nonpregnant women with acute pyelonephritis
- fluoroquinolone
What is interstitial cystitis? What patient population does it commonly affect
- bladder pain syndrome; diagnosis of exclusion
- women
- >40 yo
- often coexists with other chronic pain conditions: fibromyalgia, IBS
What is the most important central finding in interstitial cystitis
altered urothelium
-
Glycosaminoglycan (GAG) layer commonly damaged
- impedes urothelial growth -> chronic inflammation -> mast cel activation -> upregulation of sensory innervation -> pain
as interstitial cystitis progesses, fibrosis can occur, what sign is common
Glomerulations: bladder hemorrhages
What is the percentage breakdown of interstitial cystitis in terms of ulcerative and nonulcerative type
- nonulcerative type: 90%
- ulcerative type: 10%
clinical presentation
- highly variable
-
suprapubic bladder pain
- worse with bladder filling, relieved with voiding
- increased urinary frequency
- Dyspareunia (difficult or painful sexual intercourse), relationship of pain to menstruation
- males: +/- painful ejaculation
interstitial cystitis
How is interstitial cystitis diagnosed
clinically
- sx duration > or = 6 weeks
- location, character of pain
- PMH: prior recurrent UTIs, pelvic trauma, surgery, radiation
Since interstitial cystitis is a diagnosis of exclusion, what are tests you should run to make sure something else is going on
- UA with microscopy and urine culture
- check for chlamydia
- urine cytology if + smoking history
- +/- postvoid residual urine volume
- r/o bladder outlet obstruction or neuro disorder
- +/- cytoscopy -> indicated if in doubt
for interstitial cystitis treatment, what should be done to establish baseline symptoms
- voiding log
- O’Leary-Sant symptoms and problem questionnaire
- Pelvic pain and urgency/frequency questionnaire
First line tx for interstitial cystitis
- Lifestyle changes: avoid citrus, spicy food, caffeine, ETOH, carbonated beverages
- Behavior modification: bladder retraining
- Low impact exercise
- support groups
second line tx for interstitial cystitis
- oral medication
- *Tricyclic antidepressant (Amitriptyline)
-
Pentosan Polysulfate (Elmiron)
- may take 3-6 months to respond
indications for referral with interstitial cystitis
- hematuria
- complex symptoms (pain with incontinence)
- incomplete bladder emptying
- neurologic disorder that affects bladder function
- prior pelvic radiation or surgery
- not responding to initial tx with oral meds
clinical presentation
- fever
- flank pain
- N/V
- CVA tenderness
pyelonephritis
what must you do prior to initiating Abx for all pyelonephritis cases
must culture
