UTIs Flashcards
pyelonephritis symptoms
Flank/back pain
high fever, chills
headache
nausea / vomiting
spetic shock possible
+/- cystitis symptoms
most common pathogens in children
enterobacter spp
klebsiella spp
non-Abx prophylaxis
Methanamine salts - converted to formaldehyde and ammonia in acidic urine
Cranberry juice - may help with prevention (block adhereance of e-coli?)
Ascorbic acid - acidifies urine (unlikely)
body responds to UTI via ___ and ____
exfoliation and neutrophil recruitment
causes of persistence
Inadequate therapy
chonic bacteria prostatitis (infxn habored in prostate)
urethral diverticula)
fistula
urinary stasis (reflux, poor emptyting)
Nitrate dipstick utility
detects action of bacteria on dietary nitrates via nitrate reductasse
High specitivity, LOW sensitivity
rules in UTI, but negative does not rule out
reinfection =
persistence =
reinfection - from bacteria outside UT (New infection)
peristence - bacteria focus within UT (previous infxn doesn’t resolve)
bladder inflammation and resulting pain due to
leukocyte infiltration of bladder
bood dipstick detects
peroxidase activity of erythrocytes
(rxn catalyzed by myeoglobin and hemoglobin, possible false positives)
uncomplicated treatment course
complicated
uncomplicated - 3-5d Abx (sometimes up to 7d)
complicated - correct fxnl defect, Abx for 7d, often 10-14d
chemical strip test utitlity
urinary blood
pus (leukocytes)
bacteria,
pH
specific gravity
protein
glucose
complicated UTI pathogens
E coli
ENterobacteriacease (Klebm enterobacter, proteus, morganell, providencia)
Gram negativs - peseudomonas, acinetobacter
Gram positives - S aurea, Coag neg staph, GBSS, eteroccoci, Corynebacterium)
Yeast and gungi (candidia torulopsis)
Parasites (schistosoma, haematobium)
do not treat asymptomatic bacteriruria EXCEPT in cases of
pregnancy (prevent pre-term)
kids with reflux
microscopic analysis utility
definitve test for blood (RBCs) and pus (leukocytes)
false positives in dipsticks confirmed
complicated vs uncomplicated
complicated - structural or fxnl abnl of GU OR
presence of comorbidity which increases risk of infection or failure of therapy
imagin indicated for
complicated (some)
predisposing factors (GU anomalies, Hx of stones)
lack of response to therapy
recurrent pyelonephritis)
(CT is best for stones)
risk factors for asymptomatic bacturiria
elderly women
pregnancy
diabetes
use of cathetars
spinal cord injury
(generally do not treat)
Adjunvant tests for UTI
Blood testing - CBC, basic chemistry (creatinine, electroyltes
Imaging for posible hydronephrosis, stones, abscess
senstivity testing for UTI treatment response (levels)
sensitive - will likely respond to typical ABx does
Intermediate - may reequire higher ABx concentrations
Resistant - response not likely at safe levels
uncomplicated UTI pathogens
E coli
S Saphrophyticus
Enterobacteriaceasse (Klebsiella, Enterobacter, Proteus, Salmonella, Shigella)
Gram Positives ( S aureus, GBBS, enteroccoci)
species of particular importance to female UT
lactobacillus
most common UTI pathogen in adults
most common nosocomial
adults - uropathogenic e-coli (UPEC)
nosocmial - pseudomonas aerginosa
descending UTI due to
hematogenous spread
UA dipstick LE detects
leukocyte esterae - detects pyuria (WBCs in urine)
in UT, luekocytes only found in ____ during times of health
urethra
cystitis presenting symptoms
dysuria
frequency and urgency
suprapubic pain
cloudy/smelly urine
heamturia (gross is more concerning)
