UTIs Flashcards
Treatment for Uncomplicated cystitis
First line: No order
Nitrofurantoin, Fosfomycin, TMP/SMX
Second line: FQ
No evidence for cranberry juice
What are the common causative organisms of Uncomplicated Cystitis
§ 86% - E. coli § 4% - Staph saprophyticus § 3% Klebsiella § 3% Proteus species § 1.4% Eneterobacter species
what are uncomplicated conditions?
Good immune system Non Pregnant No Comorbiditis (like DM or recurrent UTIs) Premenopausal No known urologic abnormalities
What is LUTS?
dysuria, frequent voiding, small volumes, urinary urgency
Common lab findings for uncomplicated cystitis ?
UA with positive Nitrites, and Luekocyte Esterase
What is Pyelonephritis?
More serious infection, involving the kidney. Infection of the renal pelvis; Usually from ascent of the bacterial pathogen
What are the causative organisms of pyelonephritis ?
§ 82% E Coli
§ Klebsiella pneumonia
Staph Saprophyticus - resides on the skin and enters the UT via sexual intercourse
Describe Sx and physical exam findings for pyelonephritis.
LUTS
+ Fever, CVA tenderness, RIgors, nausea, vomiting, suprapubic tenderness
What are the common lab findings for pyelonephirits?
Luekocytosis (elevated WBC) with or without left ward shift
UA - Leukocyte Esterase, pyuria, hematuria
Blood cultures positive: 15-30% of cases
What physical exam finding would indicate a patient does not have urinary cystitis?
vaginal discharge
Treatment for Pyelonephritis:
Outpatient vs in-patient nonpregnant
what happens if the patient doesn’t improve?
Outpatient Empiric Therapy: FQ, but TMP/SMX if susceptible is OK but nor prefered
Inpatient:
- Initial: FQ, Aminoglycosides, imipenem
- Step down: FQ or TMP/SMX
If no improve; repated UA/cultures;
Consider imaging to assess for complications such as Perinephric abscess
what conditions classify patient’s as “complicated UTIs”
Immunodeficiency
DM
history of childhood UTI
Pregnant
Preadolescent, postmenopausal
Urologic abnormalties –stones, stents, catheters, neurogenic bladder, polycystic kidney disease
Prostate cancer, or BPH
What is the 1 scenerio of asymptomatic bacteriuria that you must treat?
Pregnant women with asymptomatic bacteruria (in the first trimester)
associated with low birth weight children
Name a urologic medical emergency in males?
Urinary tract obstruction
Pediatric UTIs;
- Diagnosis
- Treatment
- Dx; Pyruria + 50,000 CFUs
- Tx: need GRAM NEGATIVE COVERAGE
TMP/SMX, Amoxicillin, Nitrofurantoin
