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DOOS3 > UTI-Table 1 > Flashcards

UTI-Table 1 Flashcards

1
Q

What is a UTI?

A

an infection in the urinary tract from the presence of microorganisms resulting in an inflammatory response

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2
Q

What is asymptomatic bacteriuria?

A

Official: patient has no urinary symptoms, but 2 consecutive urine cultures show > 105 bacteria/mL of urine with the same microorganism
Actual life: a pt with presence of bacterimia without symptoms

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3
Q

What is an uncomplicated UTI?

A

His lecture: female
Definition: infection in an otherwise healthy, non-pregnant adult female of child-bearing age(not imp) with a structurally and functionally normal urinary tract (no abnormality that interferes with the normal flow of urine or voiding). For the purposes of this unit, only females will be classified as uncomplicated.

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4
Q

Do you tx asymptomatic bacteriuria?

A

NO leads to c diff and resistance…only tx if preggo or they are getting a urologic surgical procedure… not for test but in real life can also argue to tx peds and leukopenia

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5
Q

What is a complicated UTI?

A

infection in a patient (male or female) with a predisposing lesion of the urinary tract, neurologic deficit, or medical condition that impairs the immune system
MALE, OBSTRUCTION, or NEURO

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6
Q

What are considered lower UTI?

A

cystitis (infection of the bladder), urethritis (infection in the urethra), prostatitis (infection in the prostate gland

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7
Q

What is considered an upper UTI?

A

pyelonephritis (UTI that has ascended to affect the kidneys)

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8
Q

What is urosepsis?

A

Sepsis caused by UTI

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9
Q

Why do UTI occur more often in females?

A

female’s urethra is very short,
prostatic fluid contains antibacterial properties, hormonal changes affect adherence of bacteria to mucosa, urethral trauma during sexual intercourse, or a combination of these factors.

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10
Q

What are the 2 major routes that bacteria can enter the urinary tract and reach the kidneys through?

A

Through the bloodstream (hematogenous infection)

From the lower urinary tract (ascending infection)

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11
Q

Of the 2 routes above, which is less common?

A

hematogenous route is less common than an ascending infection, and can result in kidney infection from bacteria that arise from distant sites during septicemia or infective endocarditis

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12
Q

What pt populations are more at risk for hematogenous spread?

A

patients that have ureteral obstruction, are debilitated, or who are receiving immunosuppressive therapy

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13
Q

What does E.coli have that makes it a more common ascending infection?

A

Fimbria that stick and basically climb up

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14
Q

What pathogen should you be very suspicious of a blood stream infection if found in the urine?

A

STAPH AUREUS – this is not normal in pee

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15
Q

What steps have to occur in order to support the finding of an ascending infection?

A

1- colonization of the disal urethra
2- mvmnt of organism from urethra to bladder
3- stasis of urine
4- mvmnt of organism from bladder to renal pelvis
5- mvmnt of organism into the renal parenchyma (intrarenal reflux- can see on voiding cystourethrogram)

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16
Q

If you do a urine culture and find 3 or more organisms growing, what is likely happening?

A

This is likely NOT a UTI and probably from contamination- most likely not a clean catch

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17
Q

What are the 2 most common community acquired uncomplicated UTI organisms?

A 
E coli
Staph saprophyticus (young sexually active females)
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18
Q

What are the causative organisms in hospital acquire and/or complicated UTI?

A

Resistant Gram-negative microorganisms, including Pseudomonas aeruginosa, E. coli, K. pneumoniae, P. mirabilis
Enterococcus spp.

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19
Q

Is urine sterile?

A

Yes- this is considered a sterile site still

20
Q

What are risk factors for UTI?

A 
•Congenital abnormality
•Obstructions
oStones
•Indwelling catheter
•BPH
•Neurologic defects
•Immunocompromised
•Elderly
•Diabetes
•Sexual intercourse 
Pregnancy
21
Q

What are symptoms of a pt with lower UTI?

A 
Dysuria
Urinary urgency and frequency
Low voiding  volume
Nocturia (urge to urinate at night)
Hematuria (blood in urine)
22
Q

What are symptoms of a pt with an upper UTI?

A 
Fevers
Chills
Nausea/vomiting
Flank pain
Leukocytosis
23
Q

What are the 3 things we need to look at in a UA for diagnosis?

A

WBC (>10), LE (this is elevated if WBC are present), Nitrite

24
Q

What is the gold standard for diagnosing UTI?

A

Quantitative urine culture

25
Q

How should you start abx tx?

A

Based on UA and symptoms

26
Q

What are some good drug choices for tx UTI?

A

Cephalosporins, fluoroquinolones (not moxi), nitrofurantoin( not in pyleo), and bactrim

27
Q

What is collateral damage?

A

ecological adverse effects of antimicrobials such as the selection of drug-resistant organisms or the colonization or infection with multi-drug resistant organisms; collateral damage has been associated with the use of broad spectrum cephalosporins and fluoroquinolones.

28
Q

What is an adjunct therapy you can use OTC for analgesic effects?

A

Phenazopyridine- he does not like this

- this is not an ABX!

29
Q

What do you need to tell your pts before they take Phenazopyridine?

A

This is not an abx
It will turn your urine bright orange
Do not use more than 2 days
Do not use if CrCL

30
Q

How should you chose an ABX for uti tx?

A

Infecting organism, resistance, type of UTI, pt factors, and urinary concentration of drug

31
Q

Determining drug choice

A

Look at flow chart we were given

Depends on multiple factors

32
Q

What is re-infection?

A

UTI caused by a completely different pathogen
Typically occurs > 2 weeks after the completion of therapy for a previous UTI
>/= 3 times per year

33
Q

How should you tx re-infection?

A

Tx each event then follow with prophylactic therapy daily for 6 mo

34
Q

What can you use for prophylaxis for re-infection?

A
  • One-half SMX/TMP SS tablet
  • Nitrofurantoin 50-100mg
  • Levofloxacin 50mg PO daily – collateral damage
35
Q

What is a relapse?

A

UTI caused by the same pathogen, and occurring within 2 weeks of completion of antibiotic therapy for a previous UTI

36
Q

How are catheterized pts with UTIs tx?

A

Catheter change plus 7-14 days of abx

Need to tx only if they have systemic symptoms

37
Q

When should you consider the diagnosis of prostatitis?

A

In any male with a UTI

38
Q

What are some s/s of prostatitis?

A

Onset of high fever, chills, malaise, pain(genitourinary, pelvic, or rectal), and voiding symptoms (irritation or obstruction); -also sometimes associated with sexual dysfunction.

39
Q

What is acute bacterial prostatitis?

A

Usually from e coli and from reflux of urine from the posterior urethra or bladder

40
Q

How is acute bacterial prostatitis tx?

A

4 weeks duration of cipro, levo , or bactrim….on the boards this is apparently cipro BID x 5 weeks

41
Q

What is chronic bacterial prostatitis?

A

Recurrent UTI from the same organism common in pts d/t poor penetration of the prostate, same organisms implicated
Hard to diagnose and can be asymptomatic

42
Q

How is chronic bacterial prostatitis tx?

A

•same as acute bacterial prostatitis, just with a longer duration of therapy.
•Treat with either a FQ or SMX/TMP x 4-6 weeks.
Consider longer duration of therapy of 6-12 weeks if symptoms persist.

43
Q

How can recurrent infection be tx?

A

surgery or chronic suppressive therapy with agents such as ciprofloxacin 250 mg PO three times a week, SMX/TMP 1 SS tablet PO daily, or nitrofurantoin 100 mg PO daily

44
Q

How can you diagnose prostatitis?

A

There is no standard.
For acute
-Presence of typical symptoms of prostatitis should prompt digital rectal exam
-Finding of an edematous and tender prostate on physical exam in this setting
-Can get fluid from PE to send for culture: Massage prostate and if purulent discharge is expressed send to lab for C&S

45
Q

What is the most common form of prostatitis?

A

Chronic abacterial…same as other chronic but lack hx of recurrent UTI and no positive culture

46
Q

What is granulomatous prostatitis? What pts is it seen in?

A

Caused by a fnugal source

Immunocompromised or in pts with tx of bladder CA

47
Q

What should you consider if you have a male pt

A

STI- gonorrhea or Chlamydia usually

DOOS3 (12 decks)

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