UTIs - Exam 2 Flashcards by Johannah Crumpton

What is the MC organism for UTIs? How many organisms is common in acute? Chronic?

E. coli

acute: usually one organism

chronic: may be 2+ organisms

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What does it mean if the urine sample comes back as a mixed sample?

mixed= skin bacteria got in urine sample

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a colony count of ____ is suggestive for UTI but it is not diagnostic!

10^5 cfu/mL (>100,000 cfu/mL)

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When is bacteriuria screening recommended?

Currently pregnant

Undergoing invasive urologic procedures where mucosal bleeding is anticipated

Recent recipients of a renal transplant

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What is unresolved bacteriuria a result of?

failure to sterilize urinary tract during UTI tx. like they did not finish abx, resistance, mixed infections

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What is persistent bacteriuria a result of?

urinary tract is sterilized, but bacteriuria recurs due to persistent source of bacteria
Infected stone, prostatitis, foreign bodies, fistulas

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What is the MC method of bacterial invasion for UTIs? What are 3 other ways UTI are spread?

**Ascending- MC

direct extension
hematogenous
lymphatic

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What are 5 general risk factors for a UTI?

Abnormal voiding (including vesicoureteral reflux)

Diminished renal blood flow

Intrinsic renal disease

Abnormal urine pH, osmolality

Deficient mucosal coating

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What are 2 UTI risk factors for females? males?

female:
shortened urethra
sex

male:
prostatitis
foreskin

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What is the MC pathogen for acute cystitis? Name 5 additional ones

E. coli- MC

Proteus, Klebsiella, Pseudomonas, Staphylococci, Enterococci

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irritative voiding (dysuria, frequency, urgency), suprapubic pain, +/- gross hematuria, +/- malaise, no signs of systemic toxicity

What am I?
Will there be CVA tenderness present?
What is the tx?

acute cystitis

no CVA tenderness

tx:
Nitrofurantoin (Macrobid) - 100 mg PO BID x 5 days
OR
TMP-SMZ (Bactrim DS) - 800/160 mg PO BID x 3 days
OR
single dose fosfomycin 3g PO

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T/F: you always need to get a UA if you suspect acute cystitis?

FALSE! can skip if NO signs of systemic illness and NO risk factors for drug resistant organisms

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What are the risk factors for multi-drug resistant gram - bacteria?

Risks for MDR G- bacteria:
MDR G- bacteriuria in the past 3 months

Inpatient stay (hospital, nursing home, LTC) in the past 3 months

Quinolone, TMP-SMZ, or ESβL antibiotics in the past 3 months

Travel to areas with ↑ MDR germs (Mexico, Spain, India, Israel)

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What are the 2nd line tx options for acute cystitis? What is a good tx option for pregnant women?

Amoxicillin/clavulanic acid
cephalosporins

cephalosporins

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What are the 3rd line tx options for acute cystitis?

cipro or levo

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What are some OTC medication that can be used as adjunct medications for acute cystitis?

Phenazopyridine (Azo)
Methenamine (Hiprex)

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What is the highlighted SE of Phenazopyridine (Azo)? When it is CI? What is an important pt education point with regards to its effect on an UA?

discolored urine

CI: in renal insufficiency

should not be used before UA is analyzed because it can interfere with an in-office UA

______ MOA metabolizes into formaldehyde and ammonia in urine. What are the CI? What is an important DDI to note?

Methenamine (Hiprex)

CI: severe renal or liver insufficiency

DDI: sulfa drugs (bactrim)

What are some non-pharm tx options for acute cystitis?

Sitz baths

Increased PO fluid intake

Cranberry juice or supplement

Probiotics

Vaginal estrogen (if postmenopausal)

What are some non-pharm prevention strategies for acute cystitis?

peeing after sex
do not hold urine
drink plenty of fluids
avoid causative meds
wipe front to back
breathable undergarments
probiotics
cranberry juice supplement
D-Mannose supplement

What is the criteria for abx prophylaxis be used to treat UTIs in women? What needs to be ruled out before starting tx?

In women with 2+ UTIs in 6-months or 3+ UTIs in a 12-months

Prior to starting tx - r/o correctable etiology, more serious causes: Fistulas, infected stones, postmenopausal atrophy

What are some pharm acute cystitis prevention strategies?

Methenamine 1 g PO BID

Cranberry products - 8 oz of cranberry juice QD to BID or cranberry concentrate tablets

low dose abx qhs/prn with sex:
Bactrim
trimethoprim
nitrofurantoin
cephalexin
fosfomycin 3g q 7-10 days

What is acute pyelonephritis? What pathogens are MC? What pathogen is MC if it spread through the blood?

kidney infection

E. coli, proteus, Klebsiella, pseudomonas

staph aureus if hematologic route

irritative voiding , suprapubic pain, +/- gross hematuria, fever, chills, N/V/D, flank pain

What am I?
Will CVA tenderness be present?
What is the imaging of choice?

Acute pyelonephritis

CVA tenderness will be present

CT- preferred and US may show abscess and hydronephrosis

What kind of cast will you see in acute pyelonephritis? Why?

+/- WBC casts because it is a type of interstitial nephritis

What are the abx tx of choice for in-pt acute pyelonephritis?

ceftriaxone 1 g IV or IM x 1 dose ertapenem 1 g IV or IM x 1 dose gentamicin or tobramycin (5 mg/kg) IV or IM x 1 dose

What are the oral abx tx options for out-pt pyelonephritis?

Levo or cipro

What is the out-pt tx of acute pyelonephritis if the pt is allergic to fluoroquinolones?

tobramycin IM then 7-10 days of TMP-SMX DS 800-160 mg 1 PO BID, or amoxicillin-clavulanate 875 mg PO BID, or cefpodoxime 200 mg PO BID, or cefadroxil 1 go PO BID

What 2 abx are CI in acute pyelonephritis? Why?

nitrofurantoin, oral fosfomycin because they both go straight to the bladder which is great for acute cystitis but in pyelo need some to go to the kidneys

What is the abx tx for acute pyelonephritis in the ICU?

meropenem or imipenem + Vancomycin

What is the abx tx for acute pyelonephritis in-pt with no risk for MDR? If there is 1+ risk for MDR-G-?

IV ceftriaxone or IV/oral fluoroquinolones IV piperacillin/tazobactam or IV cefepime or IV carbapenem (meropenem, imipenem)

What are 4 complications of acute pyelonephritis?

Sepsis/Septic shock Scarring and nephron loss Chronic pyelonephritis Major renal abscess formation

What is the tx for chronic pyelonephritis?

abx for 3-6 months

What is the underlying cause of acute urethritis? What is the MC? 2nd MC?

Usually a sexually transmitted pathogen #1: Neisseria gonorrhoeae- gonococcal urethritis #2: Chlamydia trachomatis- non-gonococcal urethritis

Is acute urethritis MC in men or women?

MC in young, sexually active males

irritative voiding (dysuria, frequency, urgency), pain/pruritus at urethral meatus, urethral discharge What am I?

acute urethritis

Thick, purulent, copious discharge makes you think ______ thin, scant discharge makes you think ______

gonorrhea Chlamydia

What type of urine sample is best if you suspect acute urethritis?

first-stream sample!!

What is the tx for gonorrhea? Chlamydia? Trich?

Gonorrhea: ceftriaxone (Rocephin) 500 mg IM x 1 dose chlamydia: doxycycline 100 mg PO BID x 7 days trich: metronidazole need to tx all sexual partners!!!