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GU: Clin Med IIA > UTIs > Flashcards

UTIs Flashcards

1
Q

UTIs are MC in who?

A

women

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1
Q

pathogen of UTIs?
how is the difference between acute and chronic?

A

Coliform bacteria, especially E. coli
Uncomplicated, community-acquired
Acute - usually one organism
Chronic - may be 2+ organisms

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2
Q

diagnostic evaluations and findings of UTIs

A
  1. Colony count - 105 cfu/mL (>100,000 cfu/mL is suggestive but not diagnostic
    - Up to 50% of women with UTIs have lower counts
    - asx bacteriuria is a thing, y’all
  2. Pyuria - helpful but not required
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3
Q

Presence of bacteria in the urine
what is this term

A

Bacteriuria

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4
Q

presentation of asx bacteriuria?
MC in who?
do you screen?

A
  • colony count of >105 cfu/mL
  • In women - 2 consecutive specimens
  • MC in women with increasing age
  • Recommended not to screen in children and women
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5
Q

failure to sterilize urinary tract during UTI tx
what type of bacteriuria?
cause?

A

Unresolved
Resistance, noncompliance with tx, mixed infections

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6
Q

urinary tract is sterilized, but bacteriuria recurs due to persistent source of bacteria
what type of bacteriuria?
causes?

A

Persistent
Infected stone, prostatitis, foreign bodies, fistulas

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7
Q

methods of UTI spread
which is MC

A
  1. ascending
  2. direct extension
  3. hematogenous
  4. lymphatic - rarest
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8
Q

why are women MC affected with UTIs compared to men?

A

Short urethra in women → much higher UTI incidence
men - longer urethra, takes more effort

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9
Q

from local infected tissue (e.g., intraperitoneal abscess)
what type of UTI spread?

A

direct extension

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10
Q

what pathogen is associated with hematogenous spread of UTI

A

staph aureus

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11
Q

general risk factors for UTI

A
  • Abnormal voiding (including vesicoureteral reflux)
  • Diminished renal blood flow
  • Intrinsic renal disease
  • Abnormal urine pH, osmolality
  • Deficient mucosal coating
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12
Q

risk factors for UTIs for females and males

A

females - Shortened urethra; Sexual intercourse (“Honeymoon Cystitis”)
males - prostatitis; foreskin

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13
Q

cause of acute cystitis?

A

bacterial
E. coli, Proteus, Klebsiella, Pseudomonas, Staphylococci, Enterococci

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14
Q

MC route of acute cystitis

A

ascent up urethra

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15
Q

acute cystitis is MC in who?

A

much MC in women
Rare in adult men - investigate possible underlying etiology

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16
Q
  • irritative voiding (dysuria, frequency, urgency), suprapubic pain, +/- gross hematuria, +/- malaise
  • Exam - suprapubic tenderness possible
  • Minimal/no signs of systemic toxicity

What is the probable dx?

A

acute cystitis
should NOT see flank pain

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17
Q

is imaging needed for acute cystitis?

A

not needed in uncomplicated cases (female)
Men - consider workup of suspected underlying cause

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18
Q

lab findings of acute cystitis

A

pyuria, hematuria, bacteriuria
* Leukocyte esterase, urinary nitrite
* Urine cx - (+) for causative organism
* obtain UA/UC with initial tx

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19
Q

Is a UA always necessary when diagnosing acute cytitis?

A

may skip (treat empirically) if no s/s of systemic illness and no risk factors for drug-resistant organisms
Otherwise should obtain UA/UC with initial tx

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20
Q

risks for MDR G- bacteria

A
  • MDR G- bacteriuria in the past 3 months
  • Inpatient stay (hospital, nursing home, LTC) in the past 3 months
  • Quinolone, TMP-SMZ, or ESβL antibiotics in the past 3 months
  • Travel to areas with ↑ MDR germs (Mexico, Spain, India, Israel)
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21
Q

first-line short-term antimicrobial therapy for uncomplicated acute cystitis

A

5 days - Nitrofurantoin (Macrobid) - 100 mg PO BID
3 days - TMP-SMZ (Bactrim DS) - 800/160 mg PO BID
Alternative - Trimethoprim 100 mg PO BID
Single dose - Fosfomycin (Monurol) - 3 g PO x 1 dose

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22
Q

second line abx for uncomplicated acute cytitis

A
  • Amoxicillin/clavulanic acid 500 mg
  • Cephalosporins - cefpodoxime 100 mg, cefdinir 300 mg, cephalexin 250-500mg

all options BID x 5-7 d

23
Q

third line abx for uncomplicated acute cytitis

A

Fluoroquinolones - ciprofloxacin 250 BID, levofloxacin 500 QD

all options x 3 d

24
Q

is a repeated UA necessary for uncomplicated acute cystitis

A
  • not necessary if s/s resolve in simple cases
  • May consider repeating if concern about unresolved bacteriuria
25
Q

CI of Phenazopyridine (Azo)

A

Renal insufficiency; known hypersensitivity

26
Q

SE of Phenazopyridine

A

HA, dizziness, GI cramps, discolored urine

  • NOT for chronic/long-term use
  • Interferes with in-office UA dip
  • Rare - AKI, hemolytic anemia, methemoglobinemia
27
Q

what Urinary analgesics/antimicrobial Metabolizes into formaldehyde and ammonia in urine

A

Methenamine (Hiprex)

28
Q

which methenamine are additives to acidify the urine or provide pain relief

A

Cystex, Phosphasal

29
Q

CI of methenamine

A

Renal or severe liver insufficiency; known hypersensitivity; severe dehydration; current tx with sulfonamides

30
Q

DDI of Methenamine

A

sulfa drugs

31
Q

SE of Methenamine

A

rash, nausea, dyspepsia
* Only use long-term if instructed to do so by provider
* Rare - elevated LFTs

32
Q

other supplemental tx for uncomplicated acute cystitis

A
  • Sitz baths
  • Increased PO fluid intake
  • Cranberry juice or supplement
  • Probiotics
  • Vaginal estrogen
33
Q

non-pharm prevention of acute cystitis

A
  • Voiding - Voiding after intercourse; Minimizing urinary retention
  • Other Patient Habits - Adequate PO fluid hydration; Avoiding causative meds; Wiping “front to back;” “Breathable” undergarments
  • Supplements - Probiotics; Cranberry juice/supplement; D-mannose supplement
34
Q

pharm prevention for acute cysititis

A

Low-dose abx QHS or PRN with coitus
* TMP-SMZ 40/200 mg/d
* Trimethoprim 100 mg/d
* Nitrofurantoin 100 mg/d
* Cephalexin 250 mg/d
* Methenamine 500-1000 mg BID

35
Q

who is a good candidate for pharm tx for acute cystitis prevention

A
  • In women with 3+ UTIs in a 12-month period
  • Prior to starting tx - r/o correctable etiology, more serious causes (Fistulas, infected stones, etc.)
36
Q

what is the “kidney infection”

A

Acute Pyelonephritis

37
Q

what pathogen can be seen in Acute Pyelonephritis

A

G- bacteria most common
E. coli, Proteus, Klebsiella, Pseudomonas
May see G+ - Enterococci, Staphylococci

38
Q

MC route of acute pyelonephritis

A

ascent up urethra

39
Q

Acute Pyelonephritis is MC in who?

A

women
less common than acute cystitis

40
Q

irritative voiding , suprapubic pain, +/- gross hematuria, fever, chills, N/V/D, flank pain
Exam - fever, tachycardia, CVA tenderness
what is the dx?

A

Acute Pyelonephritis

41
Q

is imaging needed for acute pyelonephritis? is there a preferre method?

A
  • may not be indicated in uncomplicated cases
  • CT - preferred - can show renal inflammation, abscess
  • US - can show hydronephrosis, may show abscess
42
Q

labs of Acute Pyelonephritis

A
  • pyuria, hematuria, bacteriuria, +/- WBC casts
  • Leukocyte esterase, urinary nitrite possible
  • Urine CX - (+) heavy growth of causative organism
  • CBC - leukocytosis with left shift
  • Blood cx - may or may not be +
43
Q

outpatient tx for acute pyelonephritis if they are:

A
  • Able to tolerate PO fluid and abx intake
  • mild-moderate s/s, uncomplicated, compliant
44
Q

abx for outpatient acute pyelonephritis

A

oral (+/- initial IV treatment)

Initial IV options:
* ceftriaxone (Rocephin)
* ciprofloxacin (Cipro)
* gentamicin

Oral Tx options: (non FQ options need IV first)
* levofloxacin (Levaquin)
* ciprofloxacin (Cipro)
* trimethoprim-sulfamethoxazole (Bactrim DS)
* (not 1st line) - amoxicillin/clavulanate (Augmentin)

45
Q

CI abx for acute pyelonephritis

A

nitrofurantoin, oral fosfomycin
they dont stay in the kidney!!

46
Q

Unable to tolerate PO fluids/meds, severe illness, complicated case (sepsis, obstruction), non-compliant
would this pt need inpatient or outpatient tx?

A

inpatient

47
Q

inpatient tx for acute pyelonephritis

A
  • No risk for MDR G-: IV ceftriaxone, IV piperacillin-tazobactam, IV ampicillin/gentamicin, or IV/oral fluoroquinolones
  • If MDR G+ suspected - add on vancomycin, linezolid or daptomycin
  • 1+ risk factors for MDR G- : IV carbapenem (imipenem, meropenem, or doripenem)
  • If highly resistant - IV extended-spectrum cephalosporin + BL inhibitor
  • If MDR G+ suspected - add on vancomycin, linezolid or daptomycin

May switch to PO as pt improves clinically and can tolerate PO intake - 14 d total tx

48
Q

complications with acute pyelonephritis

include tx for one of the complications

A
  • Sepsis/Septic shock
  • Scarring and nephron loss
  • Chronic pyelonephritis- Requires abx tx for 3-6 mo; Similar rx to acute pyelonephritis
  • Major renal abscess formation
  • May necessitate surgical drainage
49
Q

cause of acute urethritis
MC route?

pathogen

A
  • # 1 cause Neisseria gonorrhoeae, #2 cause Chlamydia trachomatis , #3 cause - Mycoplasma genitalium
  • Trichomonas vaginalis also emerging as etiology
  • gonococcal urethritis or non-gonococcal urethritis (NGU)
  • MC route - ascent up urethra
50
Q

acute urethritis is MC in who?

A

men
* Young, sexually active males
* Occurs in women, but usually also occurs with another dx (PID, vaginitis, cystitis, etc.)

51
Q

irritative voiding (dysuria, frequency, urgency), pain/pruritus at urethral meatus, urethral discharge
probable dx?

A

Acute Urethritis

52
Q

difference between discharge seen in Acute Urethritis

A

from scanty/thin/watery to thick/purulent/copious
thick = gonococcal

53
Q

can acute urethritis asx?

A

Up to 10% of gonococcal urethritis and 42% of NGU

54
Q

PE findings include +/- inflammation at urethral meatus; urethral discharge
what is this dx

A

Acute Urethritis
May not see discharge without “milking” of urethra
Thick, purulent, copious discharge - more suggestive of gonorrhea

55
Q

tx for Acute Urethritis

A
  • Gonorrhea - ceftriaxone (Rocephin) 500 mg - 1 g IM x 1 dose
  • Chlamydia - azithromycin 1 g PO x 1 dose / doxycycline 100 mg PO BID x 7 days
  • Directed Therapy - culture and sensitivity
  • All sexual partners must also be treated
  • Reportable disease

GU: Clin Med IIA (13 decks)

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