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GU > Lecture 7: UTIs > Flashcards

Lecture 7: UTIs Flashcards

1
Q

What is the MC organism to cause an UTI?

A

E. Coli

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2
Q

How does the etiology of an acute UTI vs a chronic UTI differ?

A
  • Acute UTI: typically one organism.
  • Chronic UTI: 2+ organisms
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3
Q

What two diagnostic tests are suggestive of an UTI?

A
  • Colony count > 10^5 cfu/mL
  • Pyuria

Both are not diagnostic of UTI.

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4
Q

What is considered asymptomatic bacteriuria in women?

A

2 consecutive specimens with colony counts > 10^5

MC in women of increasing age.

Not recommended to screen in women or children.

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5
Q

What could result in unresolved bacteriuria?

A
  • Resistance
  • Noncompliance
  • Mixed infections
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6
Q

What is a persistent bacteriuria?

A

Sterilized urinary tract but still recurs due to persistent sources of bacteria.

  • Infected stones
  • Prostatitis
  • Foreign bodies
  • Fistulas
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7
Q

What is the most common spreading method of UTIs?

A

Ascending via the urethra.

Women have higher incidence due to a much shorter urethra.

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8
Q

If an UTI has a hematogenous source, what is the most likely bacteria to cause it?

A

Staph Aureus

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9
Q

What are some general risk factors for UTIs?

A
  • Abnormal voiding
  • Diminished renal blood flow
  • Intrinsic renal disease
  • Abnormal urine pH or osmolality
  • Deficient mucosal coating
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10
Q

What is the primary etiology of acute cystitis?

A

Bacterial (E. coli)

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11
Q

What is the MC route for contracting acute cystitis?

A

Ascent up the urethra

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12
Q

What are the S/S of acute cystitis?

A
  • Irritative voiding
  • Suprapubic pain
  • +/- hematuria
  • +/- malaise
  • Suprapubic tenderness

Systemic symptoms should NOT BE SEEN.

CVA tenderness would be more suggestive for pyelo.

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13
Q

What is the triad that makes up irritative voiding?

A
  • Dysuria
  • Frequency
  • Urgency
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14
Q

What imaging should we use for acute cystitis?

A

None needed unless male or complicated.

Could consider US for a male

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15
Q

What are the expected lab results for acute cystitis?

A
  • Pyuria, hematuria, bacteriuria.
  • Leukocyte esterase, urinary nitrite
  • Urine culture

UA is NOT required unless risk factors or systemic symptoms present.

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16
Q

What are the risk factors that would make an MDR G- bacteria more likely to be the underlying etiology for acute cystitis?

A
  • Infection in 3 months with MDR G-
  • Inpatient stay
  • International travel
  • Quinolone, TMP-SMZ, or ES-beta lactam abx in 3 months.
17
Q

What is the empiric therapy for acute cystitis?

A
  • 5 days of macrobid 100mg BID
  • 3 days of bactrim DS 800/160mg BID
  • 1 dose of fosfomycin 3g

Can choose any of these.

Macrobid only works on bacteriuria specifically.
DS = double strength

18
Q

What are the second-line empiric therapies for acute cystitis?

A
  • Augmentin or cefdinir/cephalexin for 5-7days BID
19
Q

What are the 3rd line therapies for acute cystitis?

A

Fluoroquinolones

20
Q

What would prompt us to order a repeat UA for acute cystitis?

A

Only if we are concerned it is unresolved.

21
Q

What drug/dye can be given as a urinary analgesic and its main concerns?

A
  • Phenazopyridine (dye)
  • Not for chronic use
  • Affects UA
  • Can cause AKI, hemolytic anemia, or methemoglobinemia

Can make urine bright orange! (prob a test question)

Should not use past 2 days!!!!!!!!!

22
Q

What drug can double as a urinary analgesic and antimicrobial? What is its MOA?

A
  • Converts parts of urine to formaldehyde and ammonia.
  • Methenamine

Usually short-term

23
Q

What are the SEs/CIs associated with methenamine?

A
  • Sulfa allergy
  • Rash
  • Nausea
  • Dyspepsia
  • CI in renal/liver insufficiency
24
Q

What is a sitz bath?

A

Sitting in a shallow basin filled with warm water.

25
Q

What are the non-pharmacologic interventions for acute cystitis?

A
  • Pee after sex
  • Pee when you can
  • Drink enough water so you pee
  • Wipe your pee front to back
  • Probiotics, cranberry juice, D-mannose

SGLT2 inhibitor could increase incidence of UTIs! (anything that ends in gliflozin?)

26
Q

What would prompt us to use abx prophylaxis for acute cystitis and the options?

A
  • 3+ UTIs in a 12-month period with no correctable etiology.
  • Bactrim, TMP, Macrobid, Keflex, Methenamine (BID)

All other abx are daily.

27
Q

What is the primary difference between acute cystitis vs pyelo?

A

Pyelo is more referred to as a kidney infection, rather than an UTI.

Same etiology, same route, same demographics

It is rare than acute cystitis (since it is essentially a more advanced version of it)

28
Q

What S/S are more unique to pyelo vs cystitis?

A
  • Fever
  • CVA tenderness
  • N/V/D
  • Flank pain
  • Tachycardia
29
Q

What is the preferred imaging modality for pyelo if imaging is desired?

A

CT, because it can show inflammation.

Overall, imaging is not required to diagnose.

Both US and CT can show abscess.

30
Q

What are the expected labs for pyelo?

A
  • Pyruia, hematuria, bacteriuria
  • WBC casts can appear
  • Leukocyte esterase, urinary nitrite
  • CBC will show leukocytosis with left shift (DIFFERENT FROM CYSTITIS)

Generally labs appear the same as they do in cystitis

31
Q

For OP tx of pyelo, what are the primary abx options?

A
  • Initial IV of rocephin, cipro, or gentamicin
  • Oral ABX: Levofloxacin, cipro, Bactrim DS
  • 5-7 days for fluoros, 14 days for others.

Augmentin is second line.

DO NOT USE MACROBID OR FOSFOMYCIN!!!!!!!!!!!!!!!!!!!!!!!!!!!!

32
Q

For IP empiric tx of pyelo, what are the primary abx options?

A
  • If no MDR G- risk: rocephin, zosyn, unasyn, or fluoroquinolones
  • 1+ MDR G- risk: carbapenems
  • For highly resistance MDR G-: ES cephalosporin + BL inhibitor
  • For MDR G+: vanco, linezolid, or daptomycin

14d of tx

DO NOT USE MACROBID OR FOSFOMYCIN!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
Zosyn has a z, so its pip/taZo
Unasyn has a u, so its amp/sUl

33
Q

What are the complications associated with pyelo?

A
  • Sepsis/shock
  • Scarring and nephron loss
  • Chronic pyelo (3-6 months of abx)
  • Abscess formation (might need I&D)
34
Q

What are the primary etiologies for acute urethritis?

A
  1. N. gonorrhea
  2. Chlamydia
  3. Mycoplasma genitalium
  4. Trichomonas vaginalis

Usually either gonococcal or non.

35
Q

What is different about demographics between urethritis vs cystitis/pyelo?

A

MC in men because urethra is long enough to become infected.

In women, urethra is short so infection goes to bladder asap.

36
Q

What are the S/S of acute urethritis?

A
  • Irritative voiding
  • Pain/itching at meatus
  • Urethral discharge
37
Q

If a patient has thick, purulent, copious discharge from their urethra, what is the more likely causative organism?

A

Gonorrhea

Will usually require milking the urethra. (awk)

38
Q

What are the labs that would suggest urethritis?

A
  • Gram stain
  • > 2WBC/hpf = presumptive
  • G- intracellular diplococci: presumed gonococcal
  • NAAT - diagnosing gono/chlamydia
  • UA: WBC esterase, pyruia, possible hematuria (need first-stream sample)

AKA you do not want them to pee out the first bit into the toilet. Different from a clean catch!!

39
Q

What is the empiric tx for acute urethritis?

A
  • Gono: rocephin
  • Chlamydia: azithromycin, but doxy is preferred (but it is 7 days only)

MUST TREAT ALL PARTNERS AND REPORT TO HEALTH DEPARTMENT

If very low risk for STI, should do a C&S in case.

GU (14 decks)

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