UTIs Flashcards
If you are not symptomatic for a UTI despite having a postive culture, do you treat?
No, typically not
What is suggestive of a UTI? Is this diagnostic?
100,000 cfu/mL (colony function units)
pyuria is also not diagnostic, but it is helpful
What is asymptomatic pyuria and when is it typically.
10^5 cfu
Less estrogen makes it easier to invade
This is why we only check if symtomatic
What is unsolved bateriuria and what can cause it?
Failure to sterilize urinary tract during UTI tx
Not taking meds correctly, resistance to AB
What can cause persistent bacteruria?
When the tract is sterilized, but there is a source of bacteria elsewehere:
Infected stone, prostatitis, foreign bodies, fistulas
What is the MC way UTIs spread and why does this make UTIs more common in women?
Ascending (90-95%)
Ascent up the urethra, bladder, ureters
Short urethra in women → much higher UTI incidence
Other than ascending, what are other ways UTIs spread?
Direct Extension - from local infected tissue (e.g., intraperitoneal abscess)
Hematogenous - rare - Staph aureus
Lymphatic - rare
What are some risk factors of UTIs?
Abnormal voiding (including vesicoureteral reflux)
Diminished renal blood flow (decreases immune response)
Intrinsic renal disease
Abnormal urine pH, osmolality (creates a more favorable environment)
Deficient mucosal coating
How does intercourse make it more common for women to get UTIs?
Honeymoon cystitis because intercourse pushes bacteria closer to bladder
What type of male is more likely to have a UTI?
Prostatitis
Foreskin (allows areas for bacteria to grow)
What is acute cystitis and what is the MC bacteria?
Typically what people have when they say “I had a bacterial infection)
Almost all bacteria
E coli is MC
If a male has recurrent UTIs, what should you investigate?
Underlying etiology like vesicouretal efflux
What is the classic triad of acute cystitis?
irritative voiding (dysuria, frequency, urgency),
suprapubic pain, +/- gross hematuria +/- malaise
What is the PE of acute cystits?
Exam - suprapubic tenderness possible
Minimal/no signs of systemic toxicity
When would you see CVA tenderness?
If pyleo - if just the bladder, you do not see it
What are the labs of acute cystitis?
Pyuria, hematuria, bacteriuria
Leukocyte esterase, urinary nitrate
Urine culture + for causative organism
When would you order a UA for acute cystits?
Don’t have to order (but can) unless
drug resistance, hospital stay, recent AB
What is the first-line AB therapy for acute cystits?
Macrobid, because it only concentrates in the urine (aka Nitrofurantoin)
What are other AB therapy for cystits that might not be first line (but still not second-line)
Bactrim (or trimethoprim if sulfa allergy)
Fosfomycin
What are the second-line and third line AB therapy of acute cystitis?
Amoxicillin/clavulanic acid, Cephalosporins
Third line
Fluroquinolones
What is the Phenazopyridine and SE?
Urinary analgesics
unknown MOA
CI: renal insuffiency or HTN
SE: discolored urine
rare: AKI, hemolytic anemia, methemoglobinemia
What is methanine?
Urinary analgesics/antimicrobials
MOA becomes ammonia
SE: rash, nausea
can elevate LFTs
What is a Sitz bath?
A bath for cystits, sit on the toilet (warm bath)
What are some other supplemetal treatments of Acute cystits?
Sitz baths
Increased PO fluid intake
Cranberry juice or supplement
Probiotics
Vaginal estrogen
What are non-pharmalogical therapy of cystits?
Voiding
Voiding after intercourse
Minimizing urinary retention
Other Patient Habits
Adequate PO fluid hydration
Avoiding causative meds
Wiping “front to back”
“Breathable” undergarments (cotton - not leather or spandix)
Supplements
Probiotics
Cranberry juice/supplement
D-mannose supplement (found in cranberries, sugar-based molecule that may coat the bladder)
What DM med can cause recurrent UTIs?
-glifazon
SGLT2 inhibtors
Itsy bittsy spider memory?
Itsy bitsy spiders climb up water spout and then you pee the spiders out
What is consider frequent UTIs?
3+ UTIs in a 12-month period
When should you do prevention of UTIs?
3+ UTIs in a 12-month period and tried other non-pharm therapy
TMP-SMZ 40/200 mg/d
Trimethoprim 100 mg/d
Nitrofurantoin 100 mg/d
Cephalexin 250 mg/d
Methenamine 500-1000 mg BID
What is pyelonephritis? What is the MC cause
Kidney infection
MC d/t bacteria
sometimes progression of cystits
What microbe can travel through hematologic route?
staph aureus
What are the s/s of pyelonephritis?
fever, chills, N/V/D, flank pain
Exam - fever, tachycardia, CVA tenderness
fever can be masked by ibruprofen
What do you order if you for imaging if you suspect pyelonephritis?
CT - preferred - can show renal inflammation, abscess
US - can show hydronephrosis, may show abscess
What are the labs of pyelo?
Labs - pyuria, hematuria, bacteriuria, +/- WBC casts
Leukocyte esterase, urinary nitrite possible
Urine culture - + for heavy growth of causative organism
CBC - leukocytosis with left shift
Blood culture - may or may not be +
What color is fluid on a CT?
Dark
What is the outpatient therapy for pyelo?
Able to tolerate PO, have help, can do oral. Can start with IV before they go
levofloxacin, ciprofloxacin, trimethoprim-sulfamethoxazole
- amoxicillin/clavulanate
treatment is longer then cystits
What is a CI of treatment for pyelo?
CI - nitrofurantoin, oral fosfomycin
Because these only make it to the urine and do not get to the kidneys
When do you do inpatient therapy for pyelo?
Unable to tolerate PO fluids/meds, severe illness, complicated case (sepsis, obstruction), non-compliant
What is the inpatient therapy?
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
What are complication of pyelo?
Worried about damage to kidneys
Sepsis/Septic shock
Scarring and nephron loss
Chronic pyelonephritis
Requires antibiotic tx for 3-6 mo
Similar medications to acute pyelonephritis
Major renal abscess formation
May necessitate surgical drainage
Why do abscess form quickly?
Kidney is delicate and the body wants to wall it off ASAP
What is acute urethritis and the MC cause?
Only the urethra is the problem
typically an STD
1 cause Neisseria gonorrhoeae
#2 cause Chlamydia trachomatis
#3 cause - Mycoplasma genitalium
#4 Trichomonas vaginalis also emerging as etiology
ascends to the urethra
MC demographic of acute urethritis
MC in sexually active young men
can occur in anyone
What are the s/s of acute urethritis?
irritative voiding (dysuria, frequency, urgency), pain/pruritus at urethral meatus, urethral discharge
Discharge - from scanty/thin/watery to thick/purulent/copious
Asymptomatic - Up to 10% of gonococcal urethritis and 42% of NGU
Which urethritis has the most discharge?
Gonorrohea
What is a NAAT used for?
diagnosis of gonorrhea/chlamydia
can get back w/in 15-30 min
How do you do a UA for urethritis?
FIRST discharge because this is where the bacteria bost likely is
Treatment of gonorrhea
ceftriaxone
Treatment of chlamydia
azithromycin
Treatment of gonorrhea
doxycycline
