1: Urinary Tract Infection Flashcards Preview

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Flashcards in 1: Urinary Tract Infection Deck (32):
0

Significant bacteriuria

10^5 colony forming units (CFU) per mL
from a midstream urine sample "clean catch"

1

10^2- 10^4 CPU per mL would indicate infection if...

-sample is taken by suprapubic aspiration
-sample is drawn from renal pelvis or ureter
-sample is drawn using an indwelling catheter

2

Acute sx UTI and asymptomatic bacteriuria for >50yrs men

due to BPH

3

Classification of UTI- UpperUT

- Pyelonephritis
- Perinephric abscess

4

Classification of UTI- LowerUT

- Cystitis
- Urethritis
- Prostatitis
- Epididymitis

5

Post-menopausal Recurrent UTI

-Decreased colonization with Lactobacilli
-Changes in vaginal pH
-Vaginal colonization with E. coli

6

Asymptomatic bacteriuria in adults- dx

Dx can be made by 2 successive urine cultures showing >10^5 CFU per mL

7

Indication for use of antibiotics in Asymptomatic bacteriuria in adults

-Pregnancy
-Urologic surgery
-Immunosupression

8

Asx Bacteriuria in Pregnancy

-Short term therapy (7 days)
-Increase risk of pyelonephritis and spontaneous abortion

9

Asx bacteriuria in Pregnancy- tx

-2nd Gen cephalosorins: Cephalexin, Cefuroxime
-Sulphonamides: caution in late pregnancy-> cause kernicterus in the newborn
-Avoid fluoroquinolones and aminoglycosides during pregnancy
-Tx pyelonephritis for 14 days and test of cure is necessary (Urinalysis)

10

Lower UTI manifestations

-Frequency
-Dysuria
-Urgency
-Suprapubic pain/ Incontinence

11

Urine culture

Not routinely indicated
indicated in diabetics, recurrent UTI, use of contraceptive diaphragm, age over 65 yrs.
-for pts who are indicated for urine culture, normal tx should be extended for 7 days**

12

Urinalysis

Pyuria: positive leukocyte esterase test
Nitrite
Bacteriuria

13

Acute uncomplicated cystitis in Women- tx

-Nitrofurantoin (5days) or TMP/SMX (3days)- DOC*
-Cotrimoxazole
-Fluoroquinolones

14

UTI in Children- dx

for First Timers, all
-Urinalysis
-Urine culture
-U/S
should be done

15

UTI in Children- complication

-Renal scarring in those 3yrs old
-HTN and Renal failure occur later in life
-Even a single documented UTI in child must be taken seriously**

16

Urine culture for children

-in all male pts <2yrs
who has a temp of 39C (102.2F) or higher**

17

U/S

Used to rule out obstructive uropathy

18

Voiding cystogram

Initial method of choice of Vesico-Ureteral reflux

19

Renal nuclear scan

Best for detecting renal scarring

20

UTI in children- tx

Outpts
-TMP/SMX: DOC**
-Amoxicillin, Cephalosporin, Carbenicillin
Inpts
-Cephalosporin, Amoxicillin, Aminoglycoside

**Treat vesicoureteral reflux with ureteral reimplantation**

21

Prevention of Catheter asso UTI

-Catheterize for short duration (<2 weeks)
-Closed sterile collecting system
-Use of pre-connected catheter-drainage tube units

22

Upper UTI- sx

-High fever**, sudden onset
-Pain below the ribs**
-Tenderness at renal angles on deep palpation

**Urinary sx may be ABSENT*

23

Pyelonephritis- tx

-Cotrimoxazole
-Fluoloquinolone
*tx for 10-14 days

24

Recurrent (>3 episodes per year)- tx

Long term maintenance therapy with
Low dose Cotrimoxazole

25

Complicated UTI- tx

-7day tx
-Ampicillin/ Gentamycin or
-Fluoloquinolone or
-Imipenem

26

Acute Prostatitis- sx

-Less than 2 months
-Perineal pain**
-Tender prostate** on DRE
-Prostatic massage may cause pus exudation

27

Acute prostatitis- tx

-TMP/SMX (Cotrimoxazole)
-Quinolones

28

Acute prostatitis- lab

Urine culture before and after prostate massage

29

Chronic prostatitis- sx

-Perineal/ Low back pain
-Firm, enlarged prostate on DRE

30

Epididymitis- Ddx

- fever, gradual onset, Pyuria, warmth
Prehn's sign: elevating the scrotum relieves pain of Epididymitis**

Testicular torsion: sudden onset, elevation of testis

31

Epididymitis- tx

Bed rest for 1-3 weeks
Scrotal elevation