UTIs

Question 1

What are the lower UTIs?

Answer 1

urethritis, cystitis, prostatits

Question 2

What are the upper UTIs

Answer 2

pyelonephritis, intrarenal abscess

Question 3

what is the microbiology definition of an infection?

Answer 3

> 100,000 org/ml. however symptoms are experienced at 100-10,000. multiple organisms suggest contamination.

Question 4

What is the most common agent for a UTI?

Answer 4

e coli

Question 5

what are some protective factors for utis?

Answer 5

long vs short urethra, bladder emptying, antibacterial properties of urine, prostatic secretions, PMNs in bladder wall

Question 6

What are risk factors for UTIs?

Answer 6

gender (female), sexual activity, pregnancy, obstruction, neurogenic bladder dysfunction, bacterial virulence factors, immunosuppressed states (sickle cell for example)

Question 7

What are the clinical symptoms of cystitis?

Answer 7

dysuria, frequency, urgency, suprapubic pain, usually afebrile, hematuria

Question 8

If there are complaints of vaginal discharge, then does that (increase or decrease) the likelihood of a UTI?

Answer 8

decreases (start suspecting std or yeast infection)

Question 9

What are some history questions you should ask for a UTI?

Answer 9

any vaginal or penile complaints? odors? itch? get a basic sexual history, pregnancy? previous utis, how many and last abx tx?

Question 10

What would you expect to find on PE for cystitis?

Answer 10

vital signs: normal temp (elevated in pyelonephritis), suprapubic pain, NO cva tenderness.

Question 11

what would you expect to see on UA for cystitis?

Answer 11

grossly cloudy, malodorous, hematuria (maybe), nitrites and leukocytes, WBCs, bacteria and NO CASTS (casts only with pyelo)

Question 12

Who needs a culture and sensitivity?

Answer 12

seriously ill patients, recently hospitalized patients, men and children, chronic utis, pregnancy

Question 13

in an otherwise healthy female, do you need to order a culture for an uncomplicated uti?

Answer 13

no!

Question 14

What are the top 4 organisms for UTIs?

Answer 14

e coli (75-95%), klebsiella, proteus, enterobac

Question 15

What is most often used for prophylaxis?

Answer 15

Trimethroprim (darwin) or bacterium, nitrofurantoin and cephalexin (current).

Question 16

Which of the abx for cystitis has resistance issues?

Answer 16

pcns and bactrim (if resistance is >20% in your community then used another drug)

Question 17

What is the dosing of bactrim?

Answer 17

DS

Question 18

What is nitrofurantoin (macro bid) effective against and who is it contraindicated in?

Answer 18

gram positive and gram negative, and it is contraindicated in patients with GFR <60 ml/min

Question 19

What are the DOC for UTIs?

Answer 19

bactrim, macrobid, (and cephalosporings according to current)

Question 20

which abx are safe in pregnancy?

Answer 20

macrobid, pcn, cephalosporins.

Question 21

What are the 2nd line drug choices for utis?

Answer 21

FQ (contraindicated in kids and pregnancy, should be used only as an alternative agent if >20% resistance exists to bactrim)

Question 22

What is fosfomycin?

Answer 22

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

Question 23

what is the recommended length of treatment?

Answer 23

7-10 days (5-7 according to darwin)

Question 24

What are some urinary analgesics?

Answer 24

pyridium. orange pee. stains

Question 25

What are some helpful suggestions for UTIs?

Answer 25

drink plenty of water, void after sex, void frequently, drink cranberry juice

Question 26

What is a recurrent UTI?

Answer 26

3 documented UTIs a year. prophylactic therapy is indicated. (bactrim or nitro)

Question 27

UTIs in pregnancy:

Answer 27

all asymptomatic bacteriuria must be treated. screen patients monthly. safe drugs are PCNs, cephalosporins. F/U with cultures. Hospitlize if suspect pyelo.

Question 28

What are the symptoms of pyelonephritis?

Answer 28

fever, flank pain, shaking, chills, irritative voiding symptoms, nause and vomiting, diarrhea, fever, tachycardia, CVA tenderness

Question 29

What is acute pyelo?

Answer 29

it is an inflammatory infectious process that involves the kidney parenchyma and renal pelvis. the infection usually ascends from the lower urinary tract

Question 30

What will labs show for acute pyelo?

Answer 30

leukocytosis and left shift (cbc) and the ua will show pyuria, bacteriauria, varying degrees of hematuria, casts,

Question 31

what are some complications of acute pyelo?

Answer 31

septic, chronic pyelo, abscess formation, scarring.

Question 32

What imaging is indicated?

Answer 32

ultrasound if indicated. could show stones

Question 33

What is the treatment for acute pyelo?

Answer 33

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.

Question 34

Who should you hospitalize for acute pyelo?

Answer 34

men and kids less than 3 months, women if they have complicating factors.

Question 35

What is a differential for dysuria?

Answer 35

cystitis, acute pyelo, vaginitis or prostatitis, urethritis, strictures

Question 36

How might a newborn or infant present with a uti?

Answer 36

nonspecific signs: fever, poor feeding, irritability.

Question 37

School age children tend to have this PE exam sign for uti

Answer 37

cva tenderness

Question 38

Do you always culture kids urine?

Answer 38

yes

Question 39

Children who suffer from a UTI are more likely to have what?

Answer 39

a congential urologic abnormality.

Question 40

If a child is less than _______, you must hospitalize them for pyelo.

Answer 40

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.