UTIs - Exam 2

Question 1

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

Answer 1

E. coli

acute: usually one organism

chronic: may be 2+ organisms

Question 1

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

Answer 1

mixed= skin bacteria got in urine sample

Question 2

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

Answer 2

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

Question 3

When is bacteriuria screening recommended?

Answer 3

Currently pregnant

Undergoing invasive urologic procedures where mucosal bleeding is anticipated

Recent recipients of a renal transplant

Question 4

What is unresolved bacteriuria a result of?

Answer 4

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

Question 5

What is persistent bacteriuria a result of?

Answer 5

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

Question 6

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

Answer 6

**Ascending- MC

direct extension
hematogenous
lymphatic

Question 7

What are 5 general risk factors for a UTI?

Answer 7

Abnormal voiding (including vesicoureteral reflux)

Diminished renal blood flow

Intrinsic renal disease

Abnormal urine pH, osmolality

Deficient mucosal coating

Question 8

What are 2 UTI risk factors for females? males?

Answer 8

female:
shortened urethra
sex

male:
prostatitis
foreskin

Question 9

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

Answer 9

E. coli- MC

Proteus, Klebsiella, Pseudomonas, Staphylococci, Enterococci

Question 10

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?

Answer 10

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

Question 11

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

Answer 11

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

Question 12

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

Answer 12

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)

Question 13

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

Answer 13

Amoxicillin/clavulanic acid
cephalosporins

cephalosporins

Question 14

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

Answer 14

cipro or levo

Question 15

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

Answer 15

Phenazopyridine (Azo)
Methenamine (Hiprex)

Question 16

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?

Answer 16

discolored urine

CI: in renal insufficiency

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

Question 17

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

Answer 17

Methenamine (Hiprex)

CI: severe renal or liver insufficiency

DDI: sulfa drugs (bactrim)

Question 18

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

Answer 18

Sitz baths

Increased PO fluid intake

Cranberry juice or supplement

Probiotics

Vaginal estrogen (if postmenopausal)

Question 19

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

Answer 19

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

Question 20

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

Answer 20

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

Question 21

What are some pharm acute cystitis prevention strategies?

Answer 21

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

Question 22

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

Answer 22

kidney infection

E. coli, proteus, Klebsiella, pseudomonas

staph aureus if hematologic route

Question 23

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?

Answer 23

Acute pyelonephritis

CVA tenderness will be present

CT- preferred and US may show abscess and hydronephrosis

Question 24

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

Answer 24

+/- WBC casts

because it is a type of interstitial nephritis

Question 25

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

Answer 25

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

Question 26

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

Answer 26

Levo or cipro

Question 27

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

Answer 27

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

Question 28

What 2 abx are CI in acute pyelonephritis? Why?

Answer 28

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

Question 29

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

Answer 29

meropenem or imipenem + Vancomycin

Question 30

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

Answer 30

IV ceftriaxone or IV/oral fluoroquinolones

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

Question 31

What are 4 complications of acute pyelonephritis?

Answer 31

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

Question 32

What is the tx for chronic pyelonephritis?

Answer 32

abx for 3-6 months

Question 33

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

Answer 33

1: Neisseria gonorrhoeae- gonococcal urethritis

Usually a sexually transmitted pathogen

#2: Chlamydia trachomatis- non-gonococcal urethritis

Question 34

Is acute urethritis MC in men or women?

Answer 34

MC in young, sexually active males

Question 35

irritative voiding (dysuria, frequency, urgency), pain/pruritus at urethral meatus, urethral discharge

What am I?

Answer 35

acute urethritis

Question 36

Thick, purulent, copious discharge makes you think ______

thin, scant discharge makes you think ______

Answer 36

gonorrhea

Chlamydia

Question 37

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

Answer 37

first-stream sample!!

Question 38

What is the tx for gonorrhea? Chlamydia? Trich?

Answer 38

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!!!