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Clin Med Renal > UTI/Pyelonephritis > Flashcards

UTI/Pyelonephritis Flashcards

1
Q

Acute cystitis or acute pyelonephritis in otherwise healthy nonpregnant adult women

A

Uncomplicated UTI

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2
Q

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

A

Complicated UTI

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3
Q

What causes pyelonephritis?

A

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

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4
Q

What are some risk factors for a UTI?

A

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

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5
Q

What accounts for 75-95% of uncomplicated UTIs?

A

E. Coli

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6
Q

How do you guide treatment of a UTI?

A

Guide by empiric antimicrobial selection against e. coli

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7
Q

What are the common clinical manifestations of acute cystitis?

A 
Dysuria
Increased urgency/frequency
Suprapubic pain/discomfort
\+/- hematuria
Voiding in small amounts
Afebrile
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8
Q

What are the common clinical manifestations of acute pyelonephritis?

A

Cystitis symptoms PLUS

  • Fever
  • Chills
  • Flank pain
  • Costovertebral angle tenderness
  • N/V
  • Sepsis, multiple organ system dysfunction, shock, AKI
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9
Q

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

A 
Pyuria 
Bacteriuria
Hematuria (varying degrees)
\+ Leukocyte esterase
\+ Nitrites
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10
Q

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

A

White cell casts

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11
Q

What is pyuria?

A

greater than 5 WBC per high powered field

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12
Q

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

A

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

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13
Q

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

A
  • Bactrim
  • Nitrofuranatoin
  • Fosfomycin

Cipro is “alternative” agent

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14
Q

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

A

Pyridium

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15
Q

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

A

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

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16
Q

When should you hospitalize a patient with acute pyelonephritis?

A 
Severe illness
High fever
Pain
Marked debility
Inability to maintain oral hydration or take PO rx
Pregnancy
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17
Q

Why should you avoid nitrofurantoin when treating pyelonephritis?

A

Does not achieve adequate renal tissue levels

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18
Q

What are some common outpatient treatments for pyelonephritis?

A

Cipro
Levofloxacin
Bactrim

19
Q

What is the common IV treatment for inpatient pyelonephritis

A

FQ or AMP + Gentamycin or ceftriaxone

20
Q

What is the theory surrounding cranberry juice and UTIs?

A

Tannins appear to prevent binding of bacteria to uroepithelial cell surfaces

21
Q

What is the cause of UTIs in postmenopausal women?

A
  • Bladder/uterine prolapse
  • Loss of estrogen causes change in flora
  • Loss of lactobacilli results in periurethral colonization of E. coli
  • Concomitant medical illness (diabetes)
22
Q

What causes UTIs in men?

A

Benign prostatic hypertrophy

23
Q

Pyelonephritis in a pregnant woman requires ??

A

Hospital admission

24
Q

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

A

Preterm birth
Low birthweight
Perinatal mortality

25
Q

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

A

E. coli

26
Q

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

A

Rx 7-14 days if febrile

Rx 5 days if immune competent and afebrile

27
Q

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

A

2nd or 3rd gen cephalosporin

28
Q

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

A

Amoxi-Clav or bactrim

29
Q

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

A

STDs

30
Q

Risk factors for UTIs in men

A

Uncircumsised

Anal intercourse

31
Q

How long is the male urethra?

A

18-20cm

32
Q

How long is the female urethra?

A

4cm

33
Q

Most common cause of nosocomial infections in the US

A

Catheter-associated UTIs

34
Q

What is a major risk factor for CAUTIs?

A

Duration of catheterization

35
Q

How long after removing a catheter should you screen urine?

A

48 hours

36
Q

How do you classify UTIs as “recurrent” UTIs?

A

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

37
Q

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

A

Vaginal estrogen

38
Q

How does vaginal estrogen work?

A

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

39
Q

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

A

Asymptomatic bacteriuria

40
Q

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

A

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

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

41
Q

Which patients should you treat if they have asymptomatic bacteriuria?

A

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

42
Q

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

A

Clean catch

43
Q

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

A

Treat empirically

Clin Med Renal (4 decks)

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