UTIs Flashcards
What are the lower UTIs?
urethritis, cystitis, prostatits
What are the upper UTIs
pyelonephritis, intrarenal abscess
what is the microbiology definition of an infection?
> 100,000 org/ml. however symptoms are experienced at 100-10,000. multiple organisms suggest contamination.
What is the most common agent for a UTI?
e coli
what are some protective factors for utis?
long vs short urethra, bladder emptying, antibacterial properties of urine, prostatic secretions, PMNs in bladder wall
What are risk factors for UTIs?
gender (female), sexual activity, pregnancy, obstruction, neurogenic bladder dysfunction, bacterial virulence factors, immunosuppressed states (sickle cell for example)
What are the clinical symptoms of cystitis?
dysuria, frequency, urgency, suprapubic pain, usually afebrile, hematuria
If there are complaints of vaginal discharge, then does that (increase or decrease) the likelihood of a UTI?
decreases (start suspecting std or yeast infection)
What are some history questions you should ask for a UTI?
any vaginal or penile complaints? odors? itch? get a basic sexual history, pregnancy? previous utis, how many and last abx tx?
What would you expect to find on PE for cystitis?
vital signs: normal temp (elevated in pyelonephritis), suprapubic pain, NO cva tenderness.
what would you expect to see on UA for cystitis?
grossly cloudy, malodorous, hematuria (maybe), nitrites and leukocytes, WBCs, bacteria and NO CASTS (casts only with pyelo)
Who needs a culture and sensitivity?
seriously ill patients, recently hospitalized patients, men and children, chronic utis, pregnancy
in an otherwise healthy female, do you need to order a culture for an uncomplicated uti?
no!
What are the top 4 organisms for UTIs?
e coli (75-95%), klebsiella, proteus, enterobac
What is most often used for prophylaxis?
Trimethroprim (darwin) or bacterium, nitrofurantoin and cephalexin (current).
Which of the abx for cystitis has resistance issues?
pcns and bactrim (if resistance is >20% in your community then used another drug)
What is the dosing of bactrim?
DS
What is nitrofurantoin (macro bid) effective against and who is it contraindicated in?
gram positive and gram negative, and it is contraindicated in patients with GFR <60 ml/min
What are the DOC for UTIs?
bactrim, macrobid, (and cephalosporings according to current)
which abx are safe in pregnancy?
macrobid, pcn, cephalosporins.
What are the 2nd line drug choices for utis?
FQ (contraindicated in kids and pregnancy, should be used only as an alternative agent if >20% resistance exists to bactrim)
What is fosfomycin?
it is only indicated in uncomplicated utis, and you mix it in with water. it SHOULD NOT BE USED with kids under 18, nursing moms or pregos
what is the recommended length of treatment?
7-10 days (5-7 according to darwin)
What are some urinary analgesics?
pyridium. orange pee. stains
What are some helpful suggestions for UTIs?
drink plenty of water, void after sex, void frequently, drink cranberry juice
What is a recurrent UTI?
3 documented UTIs a year. prophylactic therapy is indicated. (bactrim or nitro)
UTIs in pregnancy:
all asymptomatic bacteriuria must be treated. screen patients monthly. safe drugs are PCNs, cephalosporins. F/U with cultures. Hospitlize if suspect pyelo.
What are the symptoms of pyelonephritis?
fever, flank pain, shaking, chills, irritative voiding symptoms, nause and vomiting, diarrhea, fever, tachycardia, CVA tenderness
What is acute pyelo?
it is an inflammatory infectious process that involves the kidney parenchyma and renal pelvis. the infection usually ascends from the lower urinary tract
What will labs show for acute pyelo?
leukocytosis and left shift (cbc) and the ua will show pyuria, bacteriauria, varying degrees of hematuria, casts,
what are some complications of acute pyelo?
septic, chronic pyelo, abscess formation, scarring.
What imaging is indicated?
ultrasound if indicated. could show stones
What is the treatment for acute pyelo?
order urine and blood c&s, inpatient you will give IV ANTIBIOTICS (ampicillin, amino glycoside) and then follow with 14 day oral, and outpatient you will give a quinolone. you MUST do follow up urine cultures. It is okay to start abx prophylactically before sensitivities return.
Who should you hospitalize for acute pyelo?
men and kids less than 3 months, women if they have complicating factors.
What is a differential for dysuria?
cystitis, acute pyelo, vaginitis or prostatitis, urethritis, strictures
How might a newborn or infant present with a uti?
nonspecific signs: fever, poor feeding, irritability.
School age children tend to have this PE exam sign for uti
cva tenderness
Do you always culture kids urine?
yes
Children who suffer from a UTI are more likely to have what?
a congential urologic abnormality.
If a child is less than _______, you must hospitalize them for pyelo.
3 months. most others can be treated as outpatients. treat for 7-10 days and then f/u up 1 to 2 months with ua.
