UTIs Flashcards
1
Q
Cystitis
A
- Infection of the lower urinary tract (i.e. bladder)
- Almost all UTIs are due to E coli (or other gram negative enterobacteria)
- Sx of cystitis: dysuria, urgency, increased frequency, suprapubic tenderness, pelvic discomfort, small volume voiding, increased number of WBCs in urine (pyuria)
2
Q
Pyelonephritis
A
- Ascension of the bacteria into the kidney (usually) or from hematogenous spread (rarely)
- Sx similar to cystitis, but in addition: fever, flank pain, costovertebral angle (CVA tenderness, nausea, vomiting
- Should always do urine culture and susceptibility test
- Rx w/ fluoroquinolones or other antibios based on local resistance
- Do not need to extend duration of Rx if bacteremia unless endocarditis present
3
Q
Epidemiology of UTIs
A
- Mostly females, except neonates (M>F)
- In adults, most male UTIs are prostatitis
- Risk factors: abnormalities of the urinary tract (obstruction), catheters, DM, immunosuppressed pts, sexual intercourse, neurogenic bladder, bladder prolapse, pregnant women
4
Q
Pathogenesis
A
- First there is vaginal colonization and ascent via urethra
- Bacterial adhesion factors (fimbriae) allow the E coli to bind to epithelial cells
- The bacterial can penetrate cells to form intracellular reservoirs w/in the mucosa and serve as a source of recurrent infection
- LPS from E coli induces release of cytokines and allows for easier entry into bladder
- Other type of bacteria thats not GN enterobacteria: staph saprophyticus (also maybe strep)
5
Q
Schistosoma haematobium
A
- Seen in UTIs of pts recently from middle eastern countries
- Causes a macroscopic hematuria w/ dysuria and urinary frequency
- Can lead to bladder CA
6
Q
Bacterial resistance and virulence
A
- If resistance rate is >20% then don’t use that antibio (ampicillin, amoxicillin)
- Fluoroquinolones are best bet (<10%)
- Virulence mechanisms (fimbriae) present in 80% of pyelonephritis cultures and 60% of cystitis
7
Q
Clinical manifestations of UTIs
A
- Cystits: dysuria, frequency, urgency, suprapubic pain and/or hematuria
- Pyelonephritis: fever, chills, flank pain, nausea, vomiting, sepsis, multi-organ dysfxn, shock + cystitis Sx
- Dysuria may be from vaginitis or urethritis esp if there is discharge or foul odor
8
Q
Dx of UTIs
A
- PE: fever, CVA tenderness, ab exam
- Labs: urinalysis, urine culture
- Urinalysis: pyuria present in almost all cases (absence suggests alternative Dx)
- Nitrate test is sensitive, specific to enterobacteria (will not pick up strep/staph)
- Urine culture only if Sx persist w/in 3 mo of antibio initiation, in women w/ negative leukocyte esterase but positive Sx, all women w/ suspected pyelonephritis, and all men w/ Sx
- Sterile urine: test for atypical organisms (TB, chlamydia, ect), uroepithelial tumor, interstitial cystitis
9
Q
ASx bacteruria
A
- Up to 40% of elderly men and women
- Only 3 groups would benefit from Rx: pregnant women, renal Tx pts, pts undergoing genitourinary tract procedures
10
Q
Rx for UTI
A
- Nitrofurantoin
- Trimethoprim-sulfamethoxazole (bactrim)
- Fluoroquinolones
11
Q
Recurrent/complicated UTIs
A
- Relapse: infection w/ same organism
- Recurrence: infection w/ different organism
- Antibio prophylaxis does not appear to prevent recurrence
- Complicated UTIs: due to anatomical (enlarged prostate) or pharmacological factors that predispose pt to persistent infection, recurrent infection, or Rx failure
12
Q
Prostatitis
A
- Occurs in young and middle-aged men
- Usually E coli, may also be other enterococcus, proteus
- Sx: fevers, chills, malaise, dysuria, low back pain, painful ejactulation
- Almost all male UTIs due to prostatitis
- Always do gram stain and culture
- Antibios for 4-6 wks
- Fever abates and dysuria disappears w/in 2-6 days
- Negative urine culture at 7 days predicts cure in 4-6 wks
- Prostatic abscess should be considered when clinical abnormalities persist despite appropriate Rx
