UTIs Flashcards
Urinary Tract Infections epidemiology
● 8.2 million office visits annually
● 1.7 million emergency department visits annually
● $ 6 billion health care expenditures annually
● Present may differ depending on location of infection
○ Cystitis most common
● Hx/presentation, UA dip, UA micro, and/or culture
are typically sufficient to make the Dx
● 60% of women will report UTI in their lifetime
UTIs Etiology – 3 possible ways for bacteria to enter the urinary tract
● Bacteria ascension
○ Regarded as most common cause
○ Primary cause of pyelonephritis (ascension from bladder Mto the kidney)
● Direct extension of bacteria from an adjacent organ
○ Abscess or fistulas
● Hematogenous spread
○ Spread through the blood in immunocompromised
Most common presentation of UTIs
Cystitis
Causative organisms of UTIs
○ E. coli (86%)
○ Staph saprophyticus (4%)
○ Klebsiella species (3%)
○ Proteus species (3%)
○ Enterobacter species (1.4%)
○ <1% – Citrobacter species,
Enterococcus species, Pseudomonas,
Klebsiella, Proteus, Candida, viruses,
Gonorrhea, Chlamydia, etc.
Etiology – Risk Factors by Demographic
● Neonates: Uncircumcised – 85% higher incidence than uncircumcised
● Children: Bowel and bladder dysfunction, vesicoureteral reflux, prior UTI
● 16-35 years old: Intercourse (also us of diaphragm or spermicide)
● 35+ years old Obstruction, GU surgery, bladder prolapse, ureterocele, neurogenic bladder, bowel and bladder dysfunction
Etiology – Other Risk Factors of UTIs
● Post Menopausal: Lack of estrogen – tissue integrity and pH
● Obesity
● Diabetes
● Sickle cell trait
● Pregnancy
● Poor hygiene: Towelettes/wipes
● Frequent sitting
● Bubble baths
● Catheters
● Age
Urinary Tract Infections Host defense
● Estrogen: Encouraged health tissues, and stimulates lactobacillus (keeps pH down
→ decrease colonization of other uropathogens)
● Low pH of urinary tract
○ Urea
○ Lactobacillus
● Epithelial lining
○ Quick recognition of bacteria
○ Antibody production (kidneys) → decrease bacterial adherence and
cause phagocytosis
○ Cytotoxic cells secrete Mannose → bacteria (e.coli) can’t adhere to
the bladder wall as easily
● Complete void: The overlapping layers in the detrusor muscle allow for complete void
● Frequent voiding: Sensation of urgency when the bladder is full or irritated…an effort
to push out irritant
If lower tract protections to UTI fail →
bacteria can ascend the urinary tract
○ Additional host defenses will
activate leukocyte phagocytosis and
antibodies produced in the kidney
○ Inflammation and infection ensues
Coinfection of UTIs with _____ and chlamydia was demonstrated in 20% of males and 42 % of females
gonorrhea
Urethritis - Etiology
Sexually Transmitted Infection
● Gonococcal Urethritis (GU)
● Nongonococcal Urethritis (NGU)
● Recurrent/persistent Urethritis (NGU)
Urethritis Presentation/exam
● Dysuria
● Urethral pruritus
● Urethral discharge +/-
● Fever +/-
● Urinary hesitancy
○ More common with recurrent Dz
● 75% asymptomatic
Urethritis Diagnosis
● Exam
○ Urethral irritation
○ Urethral discharge +/-
● Urine amplification (NAAT PCR)
○ First void in the morning is best
○ Only accurate test for Mycoplasma
infections
● Culture of swab/discharge
Treatment of Gonococcal and/or Chlamydial Urethritis
○ Gonorrhea – Ceftriaxone 250 mg IM; single dose (99% cure rate)
○ Chlamydia – Azithromycin 1 gm; single dose
Treatment of Nongonococcal Urethritis (NGU)
○ Azithromycin 1 gm; single dose
or
○ Doxycycline 100 mg PO BID x 7 days
Treatment of Recurrent/persistent Urethritis (NGU)
If already treated with Azithromycin 1 gm single dose →
Moxifloxacin 400 mg QD x 7 days
Who else needs to be treated for urethritis
● Partner(s) must be treated
○ Partners within the last 6 months;
unless known negative test
Urethritis complications
● Males
○ Urethral strictures → infertility
● Females
○ Cervicitis → Pelvic inflammatory disease
Urethritis prevention
● Treat for both G&C
● Educated on safe-sex practices – avoiding high risk behaviors
● Routine STI screening with changing partners
● Check screening recommendation for pregnant females
