UTI/Pyelonephritis Flashcards
Acute cystitis or acute pyelonephritis in otherwise healthy nonpregnant adult women
Uncomplicated UTI
Associated with underlying condition that increases risk of infection or of failing therapy
Complicated UTI
What causes pyelonephritis?
When bacteria multiply in the bladder and travel up ureters to renal pelvis and parenchyma
What are some risk factors for a UTI?
Sexual intercourse
Diaphragm/spermicide use
Delayed post-coital micturition
History of UTI
What accounts for 75-95% of uncomplicated UTIs?
E. Coli
How do you guide treatment of a UTI?
Guide by empiric antimicrobial selection against e. coli
What are the common clinical manifestations of acute cystitis?
Dysuria Increased urgency/frequency Suprapubic pain/discomfort \+/- hematuria Voiding in small amounts Afebrile
What are the common clinical manifestations of acute pyelonephritis?
Cystitis symptoms PLUS
- Fever
- Chills
- Flank pain
- Costovertebral angle tenderness
- N/V
- Sepsis, multiple organ system dysfunction, shock, AKI
What is common to find on a urinalysis for a UTI?
Pyuria Bacteriuria Hematuria (varying degrees) \+ Leukocyte esterase \+ Nitrites
What is diagnostic for an upper urinary tract infection in a UA?
White cell casts
What is pyuria?
greater than 5 WBC per high powered field
For a urine culture to be positive, how many bacteria must there be?
Greater than 100,000 cfu/mL of the same organism
What are the 3 first line agents for uncomplicated cystitis in women?
- Bactrim
- Nitrofuranatoin
- Fosfomycin
Cipro is “alternative” agent
What can you use to treat the pain associated with a UTI?
Pyridium
When should you consider using a fluoroquinolone as a first line treatment for uncomplicated cystitis?
When patient is sulfa intolerant, had a recent drug-resistant pathogen, has had a UTI in the past 6 months, or is older and has recurrent UTIs
When should you hospitalize a patient with acute pyelonephritis?
Severe illness High fever Pain Marked debility Inability to maintain oral hydration or take PO rx Pregnancy
Why should you avoid nitrofurantoin when treating pyelonephritis?
Does not achieve adequate renal tissue levels
What are some common outpatient treatments for pyelonephritis?
Cipro
Levofloxacin
Bactrim
What is the common IV treatment for inpatient pyelonephritis
FQ or AMP + Gentamycin or ceftriaxone
What is the theory surrounding cranberry juice and UTIs?
Tannins appear to prevent binding of bacteria to uroepithelial cell surfaces
What is the cause of UTIs in postmenopausal women?
- Bladder/uterine prolapse
- Loss of estrogen causes change in flora
- Loss of lactobacilli results in periurethral colonization of E. coli
- Concomitant medical illness (diabetes)
What causes UTIs in men?
Benign prostatic hypertrophy
Pyelonephritis in a pregnant woman requires ??
Hospital admission
What is the danger to an unborn baby if the mother has a UTI/pyelonephritis while pregnant?
Preterm birth
Low birthweight
Perinatal mortality
What is the most common cause of a UTI in children?
E. coli
What are the treatment duration guidelines for treating UTIs in children?
Rx 7-14 days if febrile
Rx 5 days if immune competent and afebrile
What is the 1st line treatment for a UTI in a child?
2nd or 3rd gen cephalosporin
What are some other treatment options for a UTI in a child?
Amoxi-Clav or bactrim
What is important to consider in a differential of a patient with a UTI?
STDs
Risk factors for UTIs in men
Uncircumsised
Anal intercourse
How long is the male urethra?
18-20cm
How long is the female urethra?
4cm
Most common cause of nosocomial infections in the US
Catheter-associated UTIs
What is a major risk factor for CAUTIs?
Duration of catheterization
How long after removing a catheter should you screen urine?
48 hours
How do you classify UTIs as “recurrent” UTIs?
3 or more episodes/year (confirmed by UC) or 2 UTIs in the last 6 months
What can you give to postmenopausal women to help prevent recurrent UTIs?
Vaginal estrogen
How does vaginal estrogen work?
Shifts vaginal flora from uropathogens to lactobacillus which will lower vaginal pH and protect them from ascending infection
Isolation of a single organism on UC from an individual without s/s of UTI
Asymptomatic bacteriuria
What is the threshold for diagnosis of asymptomatic bacteriuria in women and men?
Women: At least 2 occasions of 100,000 CFU/mL
Men: At least 2 occasion of 100,000 CFU/mL
Which patients should you treat if they have asymptomatic bacteriuria?
Pregnant women - could progress to UTI or pyelonephritis
Prior to urologic procedures
Post renal transplantation
What type of urine specimen do you need to diagnose a UTI?
Clean catch
What should you do while you wait for UC results on a UTI?
Treat empirically
