UTIs Flashcards
what are 2 main consequences of UTI
- underTx
- many will develop pyelonphritis - over tX
- ABx resistance
- UTI most common reason for flouroquinolne Tx
3 steps of UTI patho
- bacterial virulence factors
- fimbriae
- adehsins - ascending spread
- E. coli
- other enterobact. - hematogenous spread
- S. aureus
- candida
2 outcomes of asymptomatic bacteruria
- resolution
2. acute cystitis
2 outcomes of acute cystitis
- resolution
2. pyelo
4 protective factors
- innate immunity (TLR -4)
- high urinary area and low Ph
- urinary tract epithelium derived protein factor
- urinary flow and micturation
def. asymtomatic bacteruria
- voided urinary sample with same species present above 10E5
- women 2 consecutive samples, men 1
- in cath - only 10E2
common in women
most common bact.
- E. coli
- Klebsiella pneumonia
- other enterobact.
- coag neg. staph
- group B strep
what are consequences in non-pregnant women
- more likely to dev. symptomatic UTI
- ABx reduced at 6 month, but not year
what are consequences in women with diabetes
- no increase in UTI
- no beneft for ABx
take home about non-symptomatic
- can have bacteria, but without Sx, there is not an issue
when is screening of benefit
only when it prevents adverse outcome
- preggers
- before URO procedures
2 risks in pregnant
- 20-30x pyeloneph
- increased with of premature
both decreases with ABx Tx
what is risk in people undergoing TURP
- 60% become bacteremic
- ABx the night before lowers risk
what is uncomplicated cystitis
- infection of bladder
- dysuria, freq, urgency
- bacteruria
- +ve leukocyte esterases, nitrites
3 principles for uncomp. cystitis
- narrow spectrum
- short course
- proven efficacy
2 Tx reccomendations
- nitrofuratoin
or - trimethoprim/sulfa
what are 3 reccomendations for reccurent acute uncomp. UTIs
- behavioral mods
- AB prophylaxis
>3/year
> confirmed by culture
- post-coital or bedtime dose - self-diagnosis and Tx
what makes pyelo uncomp. and comp.
uncomp - healthy, pre-meno, non-preg comp. - perinephric abscess - emphysematous pyelo - papillary necrosis
what is Sx of pyelo
- flank pain
- N/V
- fever
- CVA tenderness
- sepsis possible
what is ABx outpatient therapy
- low fever, no dehydration
- fluroquinolone
- trimethoprim sulfa
what is in-patient therapy (4)
IV then switch to oral - all need 14 days
- flouro
- amplicillin+gentamicin
- 3rd gen ceph
- B-lactam
what are cath assoc. UTIs
- indwelling cath
- Sx of UTI
- no other source of infection
- > 10E3 cfu
Sx of cath. UTI
- fever, rigors
- flank pain, CVA tenderness
- urgency freq, suprapubic pain
- if SCI - spacticity, auto dysreflexia
3 princincples of cath. prevention
- only place when needed
- discontinue ASAP
- consider automatic D/C times and MD reminders
4 Tx reccomnedations for caths
- culture urine before ABs
- change cath in 2 weeks
- Tx based on culture
- 7 days if prompt response, 10-14 otherwise
