UTIs Flashcards
Cystitis definition
Inflammation of the bladder (rare in males d/t longer urethra)
Urethritis definition
inflammation of the urethra, with frequent dysuria. Usually associated with STDs
Pyelonephritis definition
Inflammation of the kidneys nd the renal pelvis, with flank pain and tenderness, bacteria, pyuria and fever
Prostatitis definition
Inflammation of the prostate
Bacteriuria definition
Presence of bacteria in the urine
Relapse of UTI
- Primarily seen after a kidney infection
- Same organism that was present in the previous infection
- Onset: w/in 2 weeks after completion of therapy
- Causes: inadequate initial therapy, prostatic tissue involvement (men), renal tissue involvement, structural abnormality
Reinfection of UTI
- Primarily seen with lower tract infections
- Different organisms
- Onset: several weeks to months after therapy
- Causes: vaginal colonization with organisms from the intestinal tract, other hygienic concerns
Common pathogens that cause UTIs
E. coli (most common)
Proteus mirabilis
Klebsiella pneumoniae
Staphylococcus saprophyticus (particularly in young, sexually active females)
Predisposing factors for UTIs
Instrumentation Obstruction to free flow of urine Difficulty evacuating the bladder Females Pregnancy Sexual intercourse Decrease in host resistance: DM, cancer, chronic steroid use
Ways to diagnose UTIs
UA
Culture and sensitivity testing
UA
Pyuria and bacterial colony count of > 1000 bactera/ml of urine
Leukocyte esterase dipstick test
Nitrate assay test
Color, specific gravity, pH, glucose, protein, blood
Culture and sensitivity testing
Midstream clean catch specimen (preferred method)
Catheterization
Suprapubic bladder aspiration
Blood cultures
Clinical presentation of cystitis
Dysuria
Frequency
Urgency
Suprapubic pain
Acute uncomplicated cystitis common organisms
E. coli
S. saprophyticus
Acute uncomplicated cystitis treatment
Bactrim x 3 days
Nitrofurantoin x 5 days (avoid if pyelonephritis suspected)
FQs x 3 days (levo and cipro only)
Fosfomycin x 1 dose (avoid if pyelonephritis suspected)
Beta lactams x 3-7 days (cefdinir, cefaclor, cefpoxidime, augmentin)
Pts with acute uncomplicated cystitis but do not qualify for the short course
Recent ABX use DM Cancer Immunocompromised UT abnormality Pregnancy Hospital acquired UTI Instrumentation
Complicated cystitis preferred popul;ations
DM
> 65 yo
Recurrent infections
Complicated cystitis treatment
Duration 7-10 days
Bactrim
FQs (levo/cipro)
Augmentin
Urethritis clinical presentation
Usually associated with STD Dysuria Frequency Pyuria Treat the suspected STD
Pyelonephritis clinical presentation
Flank pain and tenderness
Bacteruria and pyruia
Fever
Acute pyelonephritis s/sx
Symtoms of cystitis plus: Loin pain CVA tenderness Fever, chills Hematuria N/V Granular casts
Chronic pyelonephritis s/sx
Absence of physical findings Occasional fever H/A Malaise Periodic flank pain Intermittent sx of lower UTI
Mild/Acute/Outpatient treatment of pyelonephritis
(uncomplicated)
Cipro 500mg BID x 7 days (or equiv XR form)
Levofloxacin 750mg QD x 5 days
Bactrim DS BID x 14 days
Oral Beta lactam x 10-14 days (cefdinir, cefaclor, cefpodoxime, augmentin)
Inpatient pyelonephritis treatment
-IV empiric therapy until clinically improved and afebrile for 24-48 hours, then may change to oral therapy to complete a minimum of 14 days total course
FQs (levo/cipro)
Aminoglycosides +/- ampicillin
Extended spectrum cephalosporin +/- aminoglycoside
Extended spectrum penicillin +/- aminoglycoside
Carbapenems +/- aminoglycoside (any carbapenems if not worried about pseudomonas)
Aztreonam (if severely allergic to the other beta-lactams) +/- aminoglycosides
Acute prostatitis clinical presentation
Chills/fever Perineal pain Nocturia Dysuria Lower abdominal and back pain Urinary urgency, retention Malaise
Chronic prostatitis clinical presentation
Neither febrile not toxic Asymptomatic between episodes of recurrent UTIs Dysuria Frequency Nocturia Pain in lower back, testicles Suprapubic and perineal pain
Prostatitis common organisms
E. coli
K. pneumoniae
Proteus spp.
P. aeruginosa
Duration of treatment for prostatitis
Acute: 21 days
Chronic: 4-6 weeks
Therapy for prostatitis
Bactrim
FQs
Recurrent UTIs
Assume that it is a reinfection with a different organism
- If < 3 episodes/yr = treat as separate occuring infection with short course
- If >3 episodes/yr or 2 UTIs w/in 6 months = long-term prophylaxis may be indicated
Medications for long-term prophylaxis of recurrent UTIs
TMP, Bactrim, nitrofurantoin, FQs
Medications for post-coital prophylaxis of recurrent UTIs
Bactrim Nitrofurantoin Keflex FQs Void after intercourse
Therapy for UTIs in pregnant patients
Duration: 7-10 days Keflex Augmentin Nitrofurantoin Bactrim (except 3rd trimester - kernicterus)
Therapy for UTIs in children
Amoxil
Augmentin
Keflex
Cefuroxime
Adjunctive urinary analgesics
Phenazopyridine (100-200mg TID after meals, PRP)
Adequate hydration
Cranberry juice
Good personal hygeine
