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Infectious Disease > UTIs > Flashcards

UTIs Flashcards

1
Q

Define cystitis

A

Inflammation of the bladder

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2
Q

Define urethritis

A

Inflammation of the urethra, with frequent dysuria (painful urination)

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3
Q

What is urethritis usually associated with?

A

STDs

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4
Q

Define pyelonephritis

A

Inflammation of the kidneys and renal pelvis

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5
Q

What are the symptoms associated with pyelonephritis?

A
  • Flank pain
  • Tenderness
  • Bacteria in the urine
  • Pus in the urine (pyuria)
  • Fever
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6
Q

Define prostatitis

A

Inflammation of the prostate

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7
Q

Define bacteruria

A

Presence of bacteria in the urine (urine is a normally sterile site)

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8
Q

Define relapse

A

Primarily seen after a kidney infection (e.g., upper infection)

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9
Q

Define reinfection

A

Primarily seen with lower tract infections

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10
Q

What organism is present with relapse?

A

Same organism that was present in previous infections

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11
Q

What organism is present with reinfection?

A

Different organism

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12
Q

When is the onset of action for relapse?

A

Within 2 weeks after completion therapy

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13
Q

When is the onset of action for reinfection?

A

Several weeks to months after therapy

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14
Q

What are the causes relapse?

A
  • Inadequate initial therapy
  • Prostatic tissue involvement (men)
  • Renal tissue involvement (e.g., stones)
  • Structural abnormality (urethral stricture or pregnancy)
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15
Q

What are the causes reinfection?

A
  • Vaginal colonization’s with organisms from the intestinal tract
  • Other hygienic causes
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16
Q

What are the most common bacterial organisms associated in UTIs?

A
  • E. coli
  • Staphylococcus saprophyticus (Gram-positive cocci)
  • Enterococcus spp.
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17
Q

What are some predisposing factors of UTIs?

A
  • Obstruction to free flow of urine
  • Difficulty in evacuating the bladder
  • Instrumentation (catheter, surgery)
  • Sexual intercourse (aka honeymoon cystitis)
  • Female gender
  • Pregnant
  • Decrease in host resistance (diabetes, cancer, steroid use)
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18
Q

How can UTIs be diagnosed?

A
  • Urinalysis

- Culture and sensitive testing

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19
Q

What can be checked in a urinalysis and confirm the diagnoses of UTIs?

A
  • Pyuria and bacterial colony count of > 10^2 bacteria/mL of urine
  • Leukocyte esterase present in neutrophil granules indicating pyuria
  • Nitrite produced by the reduction of nitrate by gram (-) bacteria
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20
Q

What should be done before examining pyuria, esterase, and nitrites in the urine?

A

Check if there are more than 3-5 epithelial cells in the urine

  • > 3-5 epithelial cells indicates a contaminated sample
  • < 3-5 epithelial cells indicates a non-contaminated sample
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21
Q

What can be checked in culture and sensitive testing to confirm diagnoses of UTIs?

A
  • Midstream clean catch specimen
  • Catheterization
  • Suprapubic bladder aspiration
  • Blood cultures
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22
Q

What is the preferred method to be done in culture and sensitive testing?

A

Midstream clean catch specimen

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23
Q

What method is invasive in culture and sensitive testing?

A

Suprapubic bladder aspiration

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24
Q

Which patients are indicated to have blood cultures done?

A
  • Fever
  • Rigors
  • Hospitalization
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25
Q

Which patients often come out positive when blood cultures are done?

A

Pyelonephritis

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26
Q

What is the clinical presentation of cystitis?

A
  • Dysuria
  • Frequency
  • Urgency
  • Suprapubic pain
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27
Q

Who falls under acute uncomplicated cystitis?

A

Patients experiencing symptoms of cystitis but are:

  • Non-pregnant
  • Young female
  • Child-bearing age
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28
Q

Is acute uncomplicated cystitis a short-term course of treatment or long-term?

A

Short-term

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29
Q

Which patients do not qualify for a short-term course of treatment?

A
  • Recent antibiotic use
  • Diabetic
  • Immunocompromised
  • Hospital-acquired UTIs
  • Instrumentation
  • Urinary tract abnormality
  • Pregnant
30
Q

Which bacterial organisms are common with cystitis?

A
  • E. coli

- Staph. saprophyticus

31
Q

What are the treatment options for acute uncomplicated cystitis?

A
  • TMP/SMX x 3 days
  • Nitrofurantoin x 5 days
  • Fluoroquinolones x 3 days
  • Fosfomycin 1 dose
  • Beta-lactams x 3-7 days
32
Q

When should tmp/smx for cystitis be avoided?

A
  • If resistant prevalence is known for > 20%

- If it has been used in past 3 months

33
Q

For cystitis, which medications should be avoided if early pyelonephritis is suspected?

A
  • Nitrofurantoin

- Fosfomycin

34
Q

What fluoroquinolones can be used for cystitis?

A
  • Levofloxaxin

- Ciprofloxacin

35
Q

Which beta-lactams can be used for cystitis?

A
  • Cefdinir
  • Cefaclor
  • Cefpodoxime
  • Amoxicillin/clavulanate
36
Q

(T/F) - Alternative beta-lactams, such as amoxicillin and ampicillin can be used for uncomplicated cystitis

A

FALSE - they have a high prevalence of resistance

37
Q

(T/F) - Cephalexin is an option to be used for uncomplicated cystitis but has less studies done

A

TRUE

38
Q

Who falls under complicated cystitis?

A

Patients experiencing symptoms of cystitis but are:

  • Diabetic
  • > 65 yo
  • Recurrent infections
39
Q

What are the treatment options for complicated cystitis?

A
  • TMP/SMX x 7-10 days
  • Fluoroquinolones (same as uncomplicated) x 7-10 days
  • Amoxicillin/clavulanate x 7-10 days
40
Q

What is the clinical presentation of urethritis?

A
  • Frequency
  • Dysuria
  • Pyuria
41
Q

How would you treat urethritis?

A

Treat the suspected STD since it’s usually associated with STDs

42
Q

There is acute and chronic pyelonephritis, which one is more common?

A

Acute pyelonephritis

43
Q

Which pyelonephritis is associated with cystitis symptoms PLUS hematuria (blood in urine)

A

Acute pyelonenephritis

44
Q

Which pyelonephritis is associated with absence of physical findings and malaise (feeling uncomfortable)?

A

Chronic pyelonephritis

45
Q

What are the treatment options for uncomplicated (acute) pyelonephritis?

A

Everything is PO

  • Ciprofloxacin 500 mg BID x 7 days
  • Ciprofloxacin XR 1 gm x 7 days
  • Levofloxacin 750 mg QD x 5 days
  • TMP/SMX DS bid x 14 days
  • Beta-lactams x 10-14 days
46
Q

Which treatment is less effective and less likely to be chosen for acute pyelonenephritis?

A

Beta-lactams

47
Q

What are the treatment options for complicated pyelonenephritis?

A
  • Fluroquinolones IV (cipro and levo)
  • Aminoglycosides +/- ampicillin
  • Extended spectrum penicillin +/- aminoglycoside
  • Extended spectrum cephalosporin +/- aminoglycoside
  • Carbapenems +/- aminoglycosides
  • Aztreonam +/- aminoglycosides
48
Q

Which treatment option would be given to a patient for complicated pyelonephritis if patient is severely allergic to other beta-lactams?

A

Aztreonam +/- aminoglycosides

49
Q

Which pyelonephritis is given at an inpatient site?

A

Complicated pyelonephritis

50
Q

Which pyelonephritis is given outpatient?

A

Uncomplicated pyelonephritis

51
Q

How long should inpatient pyelonephritis be given?

A

Given until clinically improved and afebrile for 24-48 hrs then may change to PO therapy for a total course of 14 days (minimally)

52
Q

What could be given to a patient if chlamydia is suspected?

A
  • Give IV/PO doxycycline 10 days OR

- Azithromycin x 1 dose PO

53
Q

There are two types of prostatitis, what are they?

A

Acute and chronic

54
Q

Which type of prostatitis is associated with neither febrile or toxic and asymptomatic between episodes of recurrent UTIs?

A

Chronic prostatitis

55
Q

Which type of prostatitis is associated with chills/fever and perineal pain?

A

Acute prostatitis

56
Q

What are the common bacterial organisms associated with prostatitis?

A
  • E. coli
  • K. pneumoniae
  • Proteus spp
  • P. aeruginosa
57
Q

What is the duration of treatment for chronic prostatitis?

A

4-6 weeks

58
Q

What is the duration of treatment for acute prostatitis?

A

21 days

59
Q

Which treatment options could be used for acute and chronic prostatitis?

A
  • TMP/SMX

- Fluoroquinolones (cipro and levo)

60
Q

How would a clinician treat a recurrent infection?

A

Determine the episodes that have occurred per year

61
Q

If <3 episodes have occurred per year, how would it be treated?

A

Treat as a separate occurring infection with short course of therapy

62
Q

If >/= 3 episodes per year OR 2 UTIs occurred within past 6 months, how would it be treated?

A

Long-term prophylaxis would be indicated

63
Q

What are the treatment options for recurrent UTIs?

A
  • TMP
  • TMP/SMX
  • Fluoroquinolones (cipro or levo)
  • Nitrofurantoin
64
Q

Patient experiences infections after sexual intercourse, how would it be treated?

A

Post-coital prophylaxis

  • TMP/SMX
  • Fluoroquinolones
  • Nitrofurantoin
  • Cephalexin
65
Q

What is very important to inform the patient to do after intercourse?

A

Void after intercourse (urinate after intercourse)

66
Q

What are the treatment options of therapy in UTIs during pregnancy?

A
  • Nitrofurantoin
  • Amoxicillin/clavulanate
  • Cephalexin
  • TMP/SMX
67
Q

Which treatment option for UTIs in pregnancy should be avoided during the 3rd trimester?

A

TMP/SMX

68
Q

What is the duration of therapy for UTIs in pregnant patients?

A

7-10 days

69
Q

What are the treatment options of therapy in UTIs in children?

A
  • Amoxicillin/clavulanate
  • Cephalexin
  • Amoxicillin
  • Cefuroxime
70
Q

What is important to ask when a child presents with a UTI?

A

Why did it happen?

  • Hygiene?
  • Abuse?
  • Congenital?
71
Q

What medications can be added to a patient’s treatment therapy when they experience dysuria?

A
  • Good personal hygiene
  • Adequate hydration
  • Cranberry juice
  • Phenazopyridine 100 mg-200 mg TID after meals for pain duration

Infectious Disease (41 decks)

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