UTI/Pyelonephritis

Question 1

Acute cystitis or acute pyelonephritis in otherwise healthy nonpregnant adult women

Answer 1

Uncomplicated UTI

Question 2

Associated with underlying condition that increases risk of infection or of failing therapy

Answer 2

Complicated UTI

Question 3

What causes pyelonephritis?

Answer 3

When bacteria multiply in the bladder and travel up ureters to renal pelvis and parenchyma

Question 4

What are some risk factors for a UTI?

Answer 4

Sexual intercourse
Diaphragm/spermicide use
Delayed post-coital micturition
History of UTI

Question 5

What accounts for 75-95% of uncomplicated UTIs?

Answer 5

E. Coli

Question 6

How do you guide treatment of a UTI?

Answer 6

Guide by empiric antimicrobial selection against e. coli

Question 7

What are the common clinical manifestations of acute cystitis?

Answer 7

Dysuria
Increased urgency/frequency
Suprapubic pain/discomfort
\+/- hematuria
Voiding in small amounts
Afebrile

Question 8

What are the common clinical manifestations of acute pyelonephritis?

Answer 8

Cystitis symptoms PLUS

• Fever
• Chills
• Flank pain
• Costovertebral angle tenderness
• N/V
• Sepsis, multiple organ system dysfunction, shock, AKI

Question 9

What is common to find on a urinalysis for a UTI?

Answer 9

Pyuria 
Bacteriuria
Hematuria (varying degrees)
\+ Leukocyte esterase
\+ Nitrites

Question 10

What is diagnostic for an upper urinary tract infection in a UA?

Answer 10

White cell casts

Question 11

What is pyuria?

Answer 11

greater than 5 WBC per high powered field

Question 12

For a urine culture to be positive, how many bacteria must there be?

Answer 12

Greater than 100,000 cfu/mL of the same organism

Question 13

What are the 3 first line agents for uncomplicated cystitis in women?

Answer 13

• Bactrim
• Nitrofuranatoin
• Fosfomycin

Cipro is “alternative” agent

Question 14

What can you use to treat the pain associated with a UTI?

Answer 14

Pyridium

Question 15

When should you consider using a fluoroquinolone as a first line treatment for uncomplicated cystitis?

Answer 15

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

Question 16

When should you hospitalize a patient with acute pyelonephritis?

Answer 16

Severe illness
High fever
Pain
Marked debility
Inability to maintain oral hydration or take PO rx
Pregnancy

Question 17

Why should you avoid nitrofurantoin when treating pyelonephritis?

Answer 17

Does not achieve adequate renal tissue levels

Question 18

What are some common outpatient treatments for pyelonephritis?

Answer 18

Cipro
Levofloxacin
Bactrim

Question 19

What is the common IV treatment for inpatient pyelonephritis

Answer 19

FQ or AMP + Gentamycin or ceftriaxone

Question 20

What is the theory surrounding cranberry juice and UTIs?

Answer 20

Tannins appear to prevent binding of bacteria to uroepithelial cell surfaces

Question 21

What is the cause of UTIs in postmenopausal women?

Answer 21

• Bladder/uterine prolapse
• Loss of estrogen causes change in flora
• Loss of lactobacilli results in periurethral colonization of E. coli
• Concomitant medical illness (diabetes)

Question 22

What causes UTIs in men?

Answer 22

Benign prostatic hypertrophy

Question 23

Pyelonephritis in a pregnant woman requires ??

Answer 23

Hospital admission

Question 24

What is the danger to an unborn baby if the mother has a UTI/pyelonephritis while pregnant?

Answer 24

Preterm birth
Low birthweight
Perinatal mortality

Question 25

What is the most common cause of a UTI in children?

Answer 25

E. coli

Question 26

What are the treatment duration guidelines for treating UTIs in children?

Answer 26

Rx 7-14 days if febrile | Rx 5 days if immune competent and afebrile

Question 27

What is the 1st line treatment for a UTI in a child?

Answer 27

2nd or 3rd gen cephalosporin

Question 28

What are some other treatment options for a UTI in a child?

Answer 28

Amoxi-Clav or bactrim

Question 29

What is important to consider in a differential of a patient with a UTI?

Answer 29

STDs

Question 30

Risk factors for UTIs in men

Answer 30

Uncircumsised | Anal intercourse

Question 31

How long is the male urethra?

Answer 31

18-20cm

Question 32

How long is the female urethra?

Answer 32

4cm

Question 33

Most common cause of nosocomial infections in the US

Answer 33

Catheter-associated UTIs

Question 34

What is a major risk factor for CAUTIs?

Answer 34

Duration of catheterization

Question 35

How long after removing a catheter should you screen urine?

Answer 35

48 hours

Question 36

How do you classify UTIs as "recurrent" UTIs?

Answer 36

3 or more episodes/year (confirmed by UC) or 2 UTIs in the last 6 months

Question 37

What can you give to postmenopausal women to help prevent recurrent UTIs?

Answer 37

Vaginal estrogen

Question 38

How does vaginal estrogen work?

Answer 38

Shifts vaginal flora from uropathogens to lactobacillus which will lower vaginal pH and protect them from ascending infection

Question 39

Isolation of a single organism on UC from an individual without s/s of UTI

Answer 39

Asymptomatic bacteriuria

Question 40

What is the threshold for diagnosis of asymptomatic bacteriuria in women and men?

Answer 40

Women: At least 2 occasions of 100,000 CFU/mL Men: At least 2 occasion of 100,000 CFU/mL

Question 41

Which patients should you treat if they have asymptomatic bacteriuria?

Answer 41

Pregnant women - could progress to UTI or pyelonephritis Prior to urologic procedures Post renal transplantation

Question 42

What type of urine specimen do you need to diagnose a UTI?

Answer 42

Clean catch

Question 43

What should you do while you wait for UC results on a UTI?

Answer 43

Treat empirically