8- UTI

Question 1

is precise anatomic localization of the UTI needed for effective management

Answer 1

no

Question 2

presentation of cystitis

Answer 2

symptomatic infection or inflammation of the bladder

• Dysuria, frequency, urgency
• Rare sx: hematuria, change in urine odor

Question 3

T/F UTI in males are usually considered to be complicated becaus they occur with functional or anatomical changes of the urinary tract

Answer 3

T

Question 4

most common cause of UTI in a healthy indv

Answer 4

E coli
non e coli gram -
enterococci

Question 5

examples of situations with complicated cystitis

Answer 5

• history or suggestive symptoms of obstruction (stones, cancer)
• condition that prevents you from empyting your baldder (neurogenic bladder)
• a weakened immune system
• enlarged prostate gland
• presence of urinary catheter

Question 6

T/F a pretherapy urine culture is needed for complicated cystitis diagnosis

Answer 6

T (you have an increase risk of resistant microorganism)

Question 7

management of all patients with suspected acute complicated UTI

Answer 7

urine for urinanalysis (by microscopy or dipstick)

culture with susceptibility testing

Question 8

Classes of UTI according to anatomical site

Answer 8

• Lower UTI (cystitis)
• Upper UTI (pyelonephritis)
• Catheter related urinary tract infections (CAUTI)
• Asymptomatic bacteriuria

Question 9

T/F the clinical presentation of UTI varies with anatomic site of infection

Answer 9

T

Question 10

Presentation of pyelonephritis

Answer 10

Is symptomatic infection or inflammation of the kidneys

• flank/back pain, fever, tenderness over the costovertebral angle
• Maybe sx: abdominal tenderness, tachycardia, hypotension

Question 11

Role of CT in acute complicated UTI

Answer 11

to detect anatomic or physiologic factors associated with acute complicated UTI
• CT w/out contrast is for demonstrating calculi, gas-forming infections,
hemorrhage, obstruction, and abscesses
• Contrast is needed to demonstrate alterations in renal perfusion
• CT findings of pyelonephritis include localized hypodense
lesions due to ischemia induced by marked neutrophilic infiltration and edema
• The CT can be normal in patients with mild infection

Question 12

Should you admit all pts with acute complicated UTI

Answer 12

no, admit those who are septic or critically ill, or have a persistent high fever, pain, marked debility, inability to maintain oral hydration or take oral medications

Question 13

TX for uncomplicated cystitis

Answer 13

first line (5-7 days)
Nitrofurantoine
trimethoprim/sulphametoxazole
Phosphomycin

Question 14

TX for complicated cystis or pyelonephritis

Answer 14

this is empiric tx while waiting for urine culture:

• piperacillin/tazobactam
• cefepime
• ceftazidime

IF pt has RF for antimicrobial resistant use:
meropenem
imipenem

Question 15

Define CAUTI; its main RF is

Answer 15

At least a positive urine culture with a bacterial
load ≥103 CFU/mL in a catheterized patient with
sign or symptoms of UTIs after excluding other
potential infectious sites (as symptoms are often
non specific in a catheterized patient)
- Main risk factor: duration of catheterisation

Question 16

Microbiology for CAUTI in short term catheterisation (<1 month)

Answer 16

E coli
P mirabilis
P aeruginosa
Enterococcus
Staph
Polymicrobial

Question 17

Define asymptomatic bacteriuria

Should you treat it?

Answer 17

presence of bacteria in urine (>10^5 CFU/mL) without any specific sx
- Usually it resolves on its own