UTIs- Male Flashcards
uncomplicated UTI: pt does not have a ___________ factor that would affect microbio, incidence, or recurrance rates. typically what type of person?
predisposing; young healthy person with no comorbidites and no hx of recurrent UTIs
what patients are considered to have complicated UTIs?
elderly, DM, recurrent UTIs, CA, comorbidites, and hx of known resistance
most UTIs are caused by what?
bacteria entering through the urethra
pyelonephritis develops when __________ ascend to the __________ via the __________. it can also be caused by _________ of the kidneys from ________
pathogens; kidneys; ureters; seeding; bacteremia
what is acute simple cystitis?
acute UTI that is confined to the bladder AND doesnt have normal symptoms (fever, flank pain, CVA tenderness, chills. pelvic/perineal pain)
what are two main categories of pts that require unique management of UTIs
pregnant women and renal transplant recipients
what is an acute complicated UTI?
acute UTI accompanied by signs or symptoms (fever, chills. flank pain, CVA tenderness, pelvic/perineal pain) that suggest infection beyond the bladder
what bacteria is the most common cause of uncomplicated UTIs?
E coli
E coli has ____ that help the bacteria adhere to _______ __________ in order to cause infection. ________ helps prevent E coli from adhering
pili (protein filaments); urinary structures; cranberry
what are four organisms that can cause complicated UTIs?
proteus, klebsiella, entercoccus, pseudomonas
what bacteria is more common in patients with health care exposures/instrumentation?
pseudomonas
____________ __________ is an occasional cause of pyelonephritis in young healthy women
staph saprophyticus
three risk factors for UTI with resistant organisms
1) . recent broad spectrum antimicrobial use
2) . health care exposures
3) . travels to parts of the world where multidrug resistant organisms are prevalent
uncomplicated UTI signs/symptoms (4)
urinary frequency, lower abd or back pain, cloudy and foul smelling urine, +/- fever
how to diagnosis uncomplicated UTI
based on hx, PE, and labs (PE is usually unremarkable)
what does UA show for uncomplicated UTI? (3) what test is usually not needed?
positive for nitrites, WBC esterace, and blood; culture is not done
what are three ABX options for uncomplicated UTI tx?
bactrim DS BID 3 days, keflex 500 mg BID 5-7 days or cipro 250 mg BID for 3 days
presence of ______ with or without pyuria in the absence of any UTI symptom is called _________ ___________. describe tx for this
bacteriuria; asymptomatic bacteriuria; does warrant tx in nonpregnant patients who arent undergoing urologic surgery
pt populations of people at increased risk of UTI (and could present with complicated UTIs) 8 things
CA, recurrent UTIs, urinary obstructions, neurogenic bladders, sexually active women (with STD or recurrent UTIs), postmenopausal women, men with prostate dz, and elderly
____________ and ________ ___________ are the most common predisposing factors for nosocomial UTIs
instrumentation and urinary cath
_____ ______is the most common cause of gram neg septicemia in hospitalized pts
urinary cath
________ pts are at an increased risk of UTIs; ______ pts often have complicated UTIs
diabetic; elderly
presentation signs and symptoms for complicated UTI
may present with typical UTI symptoms but elderly/comorbidly ill pts will have altered mental status, anorexia, fatigue, weakness, and vague symptoms
UA will show what for complicated UTI? what other test will you run compared to not doing in an uncomplicated UTI
positive for nitrites, WBC esterace, blood (may have elevated WBC on CBC); DO a culture
tx of complicated UTI: base off ______, may require __________ for IV ABX if unstable or septic (______ = ABX)
culture; hospitalization (Rocephin)
recurrent UTIs are more than ____ per year (with ________ testing)
4; positive
common causes of recurrent UTIs (5)
menopause, poor hygiene, frequent diarrhea, sex, spermicide use
eval for recurrent UTI includes what tests (6)
UA, microscopy positive urine cultures, pelvic exam, cystoscopy, urodynamics, renal US
tx for recurrent UTI
acute- complicated type ABX for at least 7 days prophylaxis- macrobid, trimethoprim, or keflex ABX as needed
_______ for prevention of recurrent UTIs in premenopausal women
fluids
uncomplicated cystitis ABX: best for pregnancy? other good one but requires renal monitoring
macrobid- preg
keflex- renal dose adjustment
complicated cystitis: tx may require ________. initial ABX therapy is _______ and then step down PO is ______
culture; ceftriaxone 1-2 weeks and then keflex 10-14 days
uncomplicated pyelonephritis ABX for initial and step down therapy
initial- ceftriaxone 10-14 days and then keflex 10-14 days (OBTAIN cultures)
after 50, __________ ________ becomes more common which can cause obstruction and increased risk of ______
prostatic hyperplasia; UTI
UTI is the ____ most common infection in the elderly
2nd
UTIs in elderly are more common for those living where or with what?
living in nursing home/extended care and who have indwelling cath
elderly people with UTI present with what four things that are different than normal UTI symptoms?
altered mental status, fatigue, weakness, anorexia
tx for UTIs in elderly
IV or PO ABX, removal of cath if possible
some elderly pts with ________ ______ may have chronic asymptomatic bacteria which does or does not need ABX?
indwelling catheters; does not
the ______ fluid in men has antimicrobial properties
prostatic fluid
on a culture, a true UTI is presented when there are >_________ colony forming units of bacteria per mL of urine
greater than 100,000
send culture on ____, _______ women, people with __________ UTIs
kids; pregnant; complicated
if the patient has progressed to _______, figure out the cause and fix it, plus add ____ and _____
urosepsis; IVFs and ABX
fluoroquinolones have black box warning for ___ ______
CNS toxicity
