UTIs Flashcards
Define cystitis
Inflammation of the bladder
Define urethritis
Inflammation of the urethra, with frequent dysuria (painful urination)
What is urethritis usually associated with?
STDs
Define pyelonephritis
Inflammation of the kidneys and renal pelvis
What are the symptoms associated with pyelonephritis?
- Flank pain
- Tenderness
- Bacteria in the urine
- Pus in the urine (pyuria)
- Fever
Define prostatitis
Inflammation of the prostate
Define bacteruria
Presence of bacteria in the urine (urine is a normally sterile site)
Define relapse
Primarily seen after a kidney infection (e.g., upper infection)
Define reinfection
Primarily seen with lower tract infections
What organism is present with relapse?
Same organism that was present in previous infections
What organism is present with reinfection?
Different organism
When is the onset of action for relapse?
Within 2 weeks after completion therapy
When is the onset of action for reinfection?
Several weeks to months after therapy
What are the causes relapse?
- Inadequate initial therapy
- Prostatic tissue involvement (men)
- Renal tissue involvement (e.g., stones)
- Structural abnormality (urethral stricture or pregnancy)
What are the causes reinfection?
- Vaginal colonization’s with organisms from the intestinal tract
- Other hygienic causes
What are the most common bacterial organisms associated in UTIs?
- E. coli
- Staphylococcus saprophyticus (Gram-positive cocci)
- Enterococcus spp.
What are some predisposing factors of UTIs?
- 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)
How can UTIs be diagnosed?
- Urinalysis
- Culture and sensitive testing
What can be checked in a urinalysis and confirm the diagnoses of UTIs?
- 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
What should be done before examining pyuria, esterase, and nitrites in the urine?
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
What can be checked in culture and sensitive testing to confirm diagnoses of UTIs?
- Midstream clean catch specimen
- Catheterization
- Suprapubic bladder aspiration
- Blood cultures
What is the preferred method to be done in culture and sensitive testing?
Midstream clean catch specimen
What method is invasive in culture and sensitive testing?
Suprapubic bladder aspiration
Which patients are indicated to have blood cultures done?
- Fever
- Rigors
- Hospitalization
Which patients often come out positive when blood cultures are done?
Pyelonephritis
What is the clinical presentation of cystitis?
- Dysuria
- Frequency
- Urgency
- Suprapubic pain
Who falls under acute uncomplicated cystitis?
Patients experiencing symptoms of cystitis but are:
- Non-pregnant
- Young female
- Child-bearing age
Is acute uncomplicated cystitis a short-term course of treatment or long-term?
Short-term
Which patients do not qualify for a short-term course of treatment?
- Recent antibiotic use
- Diabetic
- Immunocompromised
- Hospital-acquired UTIs
- Instrumentation
- Urinary tract abnormality
- Pregnant
Which bacterial organisms are common with cystitis?
- E. coli
- Staph. saprophyticus
What are the treatment options for acute uncomplicated cystitis?
- TMP/SMX x 3 days
- Nitrofurantoin x 5 days
- Fluoroquinolones x 3 days
- Fosfomycin 1 dose
- Beta-lactams x 3-7 days
When should tmp/smx for cystitis be avoided?
- If resistant prevalence is known for > 20%
- If it has been used in past 3 months
For cystitis, which medications should be avoided if early pyelonephritis is suspected?
- Nitrofurantoin
- Fosfomycin
What fluoroquinolones can be used for cystitis?
- Levofloxaxin
- Ciprofloxacin
Which beta-lactams can be used for cystitis?
- Cefdinir
- Cefaclor
- Cefpodoxime
- Amoxicillin/clavulanate
(T/F) - Alternative beta-lactams, such as amoxicillin and ampicillin can be used for uncomplicated cystitis
FALSE - they have a high prevalence of resistance
(T/F) - Cephalexin is an option to be used for uncomplicated cystitis but has less studies done
TRUE
Who falls under complicated cystitis?
Patients experiencing symptoms of cystitis but are:
- Diabetic
- > 65 yo
- Recurrent infections
What are the treatment options for complicated cystitis?
- TMP/SMX x 7-10 days
- Fluoroquinolones (same as uncomplicated) x 7-10 days
- Amoxicillin/clavulanate x 7-10 days
What is the clinical presentation of urethritis?
- Frequency
- Dysuria
- Pyuria
How would you treat urethritis?
Treat the suspected STD since it’s usually associated with STDs
There is acute and chronic pyelonephritis, which one is more common?
Acute pyelonephritis
Which pyelonephritis is associated with cystitis symptoms PLUS hematuria (blood in urine)
Acute pyelonenephritis
Which pyelonephritis is associated with absence of physical findings and malaise (feeling uncomfortable)?
Chronic pyelonephritis
What are the treatment options for uncomplicated (acute) pyelonephritis?
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
Which treatment is less effective and less likely to be chosen for acute pyelonenephritis?
Beta-lactams
What are the treatment options for complicated pyelonenephritis?
- Fluroquinolones IV (cipro and levo)
- Aminoglycosides +/- ampicillin
- Extended spectrum penicillin +/- aminoglycoside
- Extended spectrum cephalosporin +/- aminoglycoside
- Carbapenems +/- aminoglycosides
- Aztreonam +/- aminoglycosides
Which treatment option would be given to a patient for complicated pyelonephritis if patient is severely allergic to other beta-lactams?
Aztreonam +/- aminoglycosides
Which pyelonephritis is given at an inpatient site?
Complicated pyelonephritis
Which pyelonephritis is given outpatient?
Uncomplicated pyelonephritis
How long should inpatient pyelonephritis be given?
Given until clinically improved and afebrile for 24-48 hrs then may change to PO therapy for a total course of 14 days (minimally)
What could be given to a patient if chlamydia is suspected?
- Give IV/PO doxycycline 10 days OR
- Azithromycin x 1 dose PO
There are two types of prostatitis, what are they?
Acute and chronic
Which type of prostatitis is associated with neither febrile or toxic and asymptomatic between episodes of recurrent UTIs?
Chronic prostatitis
Which type of prostatitis is associated with chills/fever and perineal pain?
Acute prostatitis
What are the common bacterial organisms associated with prostatitis?
- E. coli
- K. pneumoniae
- Proteus spp
- P. aeruginosa
What is the duration of treatment for chronic prostatitis?
4-6 weeks
What is the duration of treatment for acute prostatitis?
21 days
Which treatment options could be used for acute and chronic prostatitis?
- TMP/SMX
- Fluoroquinolones (cipro and levo)
How would a clinician treat a recurrent infection?
Determine the episodes that have occurred per year
If <3 episodes have occurred per year, how would it be treated?
Treat as a separate occurring infection with short course of therapy
If >/= 3 episodes per year OR 2 UTIs occurred within past 6 months, how would it be treated?
Long-term prophylaxis would be indicated
What are the treatment options for recurrent UTIs?
- TMP
- TMP/SMX
- Fluoroquinolones (cipro or levo)
- Nitrofurantoin
Patient experiences infections after sexual intercourse, how would it be treated?
Post-coital prophylaxis
- TMP/SMX
- Fluoroquinolones
- Nitrofurantoin
- Cephalexin
What is very important to inform the patient to do after intercourse?
Void after intercourse (urinate after intercourse)
What are the treatment options of therapy in UTIs during pregnancy?
- Nitrofurantoin
- Amoxicillin/clavulanate
- Cephalexin
- TMP/SMX
Which treatment option for UTIs in pregnancy should be avoided during the 3rd trimester?
TMP/SMX
What is the duration of therapy for UTIs in pregnant patients?
7-10 days
What are the treatment options of therapy in UTIs in children?
- Amoxicillin/clavulanate
- Cephalexin
- Amoxicillin
- Cefuroxime
What is important to ask when a child presents with a UTI?
Why did it happen?
- Hygiene?
- Abuse?
- Congenital?
What medications can be added to a patient’s treatment therapy when they experience dysuria?
- Good personal hygiene
- Adequate hydration
- Cranberry juice
- Phenazopyridine 100 mg-200 mg TID after meals for pain duration
