UTI & Pyelonephritis

Question 1

Acute Cystitis
- etiology
- pathology
- risk factors

Answer 1

Etiology
- bladder infection (and lower UT) due to e. coli mostly, could be adenovirus in kids
- women > men

Pathology
- e. coli climb the urethral tract and infect bladder

Risk factors
- recent sex
- history of STI
- spermicide use, condoms, etc.
- DM: more sugar in urine = good for bugs
- structural or functional abnormalities

Question 2

Acute Cystitis
- Signs/symptoms
- diagnosis
- treatment

treatment allergies
pregnant
MDR pts.

Answer 2

Symptoms
- dysuria (burning when peeing)
- frequency/urgency urination
- superpubic discomfort/ tenderness
- hematuria

Diagnosis
- urinalysis (dip stick) or microscopyto assess: pyuria (pus), bacteriuria or hematuria
- –> dip stick shows leukocytes & nitrates
- urine culture with sensitivity: to assess the organism, epesically if recurrent infection & determine medication usage
- dont need to do imaging; if systematic you could

Treatment
- Nitrofurantoin x 5-7 days
- furosimide x single dose
- bactrum (TMX-SMX) x 3 days
- avoid florquinolones because of all the adverse reactions
- allergic: amoxicillin-clavulanate, or cephalosporins
non-pharm: OTC phenazopyridine (for pain relief)

Pregnant: must treat UTI –> nitrofurantoin or fosfomycin or beta-lactams

MDR: get hx. culutre and treat, finsih abx.

Question 3

UTI in males
- patho
- risk factors
- signs
- diagnosis
- treatment

Answer 3

etiology : still e. coli, less common
patho
- anal intercourse, uncircumcised

signs
- dysuria, urgent/frequent urination, pain

diagnosis
- UA
- urine culture
- STD panel (if suspicious)

can consider imaging to confirm or r/o other diagnosis
- abdominal US
- postvoid residual testing
- cystoscopy
- can do CT as follow up

Treatment
- same as women: mitrofurantoin, TMP-SMX, fosfomycin

– if acute prostatitis : cipro or levo

Question 4

Recurrent UTIs
- define
- risk factors
- reinfection v relapse
- prevention
- treatment

Answer 4

recurrent UTI: 2+ infections in 6 months OR 3+ infections in one year

Risk Factors
- females MC
- high risk sex
- urinary function abnormalities
- genetic

reinfection: associated with simple cystitis; occurring MORE THAN 2 weeks after the previous one & can be same or diffferent bacteria

relapse: evaluate further; occurs WITHIN 2 weeks of the last infection after you complete treatment; normally the same strain of bacteria

no need for imaging usually

Prevention
- change behaviors : pee after sex!
- increase fluids
- contracetion cahgnes
- hygiene!

Treatment
- post-sex prophylaxis (nitro or bactrum)
- continuous (low dose nitro or bactrum)

Question 5

Pyelonephritis
etiology
pathology

Answer 5

etiology: when the bacteria climb up to infect the kidney (parenchyma and renal pelvis)

• most commonly still E. coli can be other gram negatives (klebsiella, enterbacter, pseudomonas) or gram postives (staph or enterococci)

Pathology
- climsb from the lower UT to teh upper and impacts kidneys

Question 6

Pyleonephritis
signs and symptoms
diagnosis
treatment

Answer 6

symptoms
- fevers & chills
- flank pain & costovertebral angle tenderness
- urgent/frequent urination
- nausea/vomiting

Diagnosis
- CBC with diff : inc. WBC with left shift neutrophils
- UA : pyuria, bacteria dn hematuria
- culture
- renal US: can see hydronephrosis
- CT scan: see decreased perfusion of the kidney
- +/- LFTs: to see and r/o liver issues

Treatment
- in-patient: IV ampucillin + genta., ceftriaxone or ciprofloxicin
- out-pt (come in and D/C): IV ceftriaxone, ciprofloxicin or gentamycin then d/c with oral cipro or levo or bactrum

Question 7

Renal Abscess
etiology
pathology
risk factors

Answer 7

etiology
- not common; caused by a UTI
- e. coli most commone staph aureus (heme. spread from elsewhere) too

Pathololgy
- infection to kidney (pyelonephritis) directly infects the kidney
- impacts the vasculature and transports organsim
- creates abscess and potential to rupture (spread to the spaces around the kidney)

Risk Factors
- nephrolithiasis
- anatomical abnormalities
- urologic surgery
- trauma
- DM

Question 8

Renal Abcess
- signs and symptoms
- diagnosis
- treatment

Answer 8

signs and symptoms
- nonspecific signs
- flank pain and abdominal pain
- fever!!!
- referred paint to the groin and the leg

Diagnosis
- CBC with diff.
- UA
- urine culture
- BMP (assess kidney function)
- inflammatory markers +/- CRP,ESR

Imaging: renal US and abdominal CT

Treatment
- drain th epus and give abx.

• drainge: ** < 5cm in diameter: no need to drain, if >5 cm then drain percutaneously** can leave catheter in until discharge or up to 7 days
• antibiotics: IV vanco + mereopenem/imipenem
  oral (bacturm, levo or cipro)

Question 9

indications to think about a renal absess for your pt. post treament of suspected UTi
(4)

Answer 9

• they’re still febrile after 4-5 days of treatment
• they have MULTIPLE bacteria in their culture
• history of multiple kidney stones
• have fever + pyuria but a sterile urince cx. !!!