UTI, pyelonephritis, sepsis Flashcards
Urethritis
-no upper tract symptoms
predisposing factors
1) Frequent intercourse
2) Multiple partners
3) Inconsistent condom use
best test for urethritis due to STI
Antigen for GC & Chlamydia**- risk of STI;
will not show on standard urine dip, micro
or cultures
predisposing factors for UTI’s in women
Use of spermicide as with diaphragm for
contraception
Frequent sexual intercourse
20 – 30 % have recurrence
Diabetic women 2-3 times higher
incidence of UTI’s than non-diabetics
(There isn’t sufficient information
regarding diabetic men)
Recurrence in post-menopausal females thought related to: - History of pre-menopausal UTI’s - Anatomic factors affecting bladder emptying ○ Cystoceles ○ Urinary Incontinence ○ Residual urine - Tissue effect of estrogen depletion
predisposing factors of UTI in men
Prostatic hypertrophy
Non-circumcised – E coli more likely to
colonize glans & prepuce (foreskin)
Asymptomatic bacteriuria (ABU):
urine sample is obtained for another reason & shows bacteria on microscopic evaluation - Health screening - Diabetes follow-up
*dont treat unless symptomatic
uncomplicated UTI
Non-pregnant female
No anatomic abnormalities
No instrumentation of the urinary tract
UTI much more common in females until
mid-life
complicated UTI occurs in
ANY pregnant female since:
- 2 patients
- Can lead to premature labor
- Low birth-weight babies
Complicated UTI’s can occur in men or women - Anatomic variant eg polycystic kidneys - Foreign body in the urinary tract ○ Stones ○ Urinary catheters ○ Nephrostomy tubes/ureteral stents - Extrinsic compression of ureter/bladder ○ Tumors ○ Profound constipation ○ Other anomalies - Immune suppression conditions ○ Diabetes ○ Drug induced ○ HIV/AIDS
Untreated Asymptomatic Bacteriuria in pregnant pts
likely to
result in symptomatic pyelonephritis in a
pregnant patient
- More likely to develop sepsis
*TREAT
whats the most imp thing to do with complicated UTIS
-take HISTORY
urethral stent
– placed to help pass stones or
keep ureter open with extrinsic masses eg
colon or GYN
Differential Diagnosis – Dysuria
in female
Urethritis
- Gonorrhea
- Chlamydia
- Herpes
Cystitis – frequency, urgency, nocturia,
hesitancy, hematuria
Vaginitis
- Candida
- Trichomonas
Cervicitis
- Chlamydia
- Neisseria
Non-infectious vaginal or vulvar irritation
interstitial cystitis
Aka “Painful Bladder Syndrome” Chronic – in contrast to acute infectious process Etiology unknown Possible contributing factors - Chronic bladder infection - Inflammatory factors - Unusual pain sensitivity - Functional co-morbidities
Differential Diagnosis – Dysuria
in males
Urethritis
- Gonorrhea
- Chlamydia
Cystitis
Prostatitis
Pyelonephritis
diagnostics for dysuria
UA (Urinalysis)
- Urine dipstick (aka reagent strip)
- Urine microscopic
Urine culture and sensitivity – will not
identify GC and Chlamydia
Must order urinary antigen for GC and
Chlamydia if STI (Sexually Transmitted
Infection) is suspected**
when is a urine culture not indicated?
when dip and micro are negative
antibiotics for GC
ceftriaxone and Azithromycin
antibiotics for chlamydia
-azithromycin or doxycycline
antibiotics for cystitis
trimethoprim-sulfamethoxazole
antibiotics for pyelonephritis
fluoroquinolone eg levofloxacin
prostatitis
Infectious or non-infectious With or without hypertrophy Can be chronic in prostatic hypertrophy Pain in prostatic, pelvic or perineal area (“where I sit down"
Prolonged antibiotic course necessary
4-6 weeks
when should you use a nephrostomy tube?
- bad hydronephrosis
- bad metastatic cancer
pyelonephritis
Generally sicker Fevers/chills Body aches esp back (flank) pain Typically ascending from lower tract infection Positive CVA (Costovertebral Angle) tenderness
test for pyelonephritis
-lloyds punch
most common precursors of pyelonephritis
Same as UTI - Since most commonly ascending from lower tract - Most common organism is E. Coli Bacteremia develops in 20-30 % of cases Can be hematogenous spread to kidney instead of ascending, but very rare - Candida - Salmonella - Staph aureus
