UTI and prostatitis

Question 1

what is UTI or prostatitis?

Answer 1

infection in any part of the urinary system (kidney, urther, bladder, urethra)

Question 2

What are examples of bladder infections?

Answer 2

lower UTI or cystitis

Question 3

what are examples of kidney infections?

Answer 3

pyelonephritis, or upper UTI

Question 4

Asymptomatic bacterimia

Answer 4

a significant amount of bacteria in urine without any signs and symptoms

Question 5

uncomplicated UTI

Answer 5

lower tract (cystitis) that presents with dysuria, urgency, frequency, and suprapubic tenderness

Question 6

complicated UTI

Answer 6

metabolic, functional, and structural abnormality that may involve both the upper and lower tracts. increased rate of treatment failure

Question 7

What does catherization put u at risk fro?

Answer 7

cathertization in the last 48 hours puts you at risk for developing a UTI

Question 8

what is pyelonephritis and what’s it due to?

Answer 8

inflammation of the renal parenchym, calcies, and pelvis
infection due to bacteremia

Question 9

what is urosepsis due to?

Answer 9

reuslts from infection of extravasated urine or the obstruction of infected urine

Question 10

HOw do we test for these conditons?

Answer 10

Via urinalysis

Question 11

what tests does urinalysis include?

Answer 11

lots

Question 12

how do we collect urinalalysi samples?

Answer 12

midstream catch

catheter (note on label)

Question 13

what can we expect to see in a UTI urinalysis?

Answer 13

1. bacteremia
2. hematuria
3. Nitrites ( presence of bacteria that convert nitrates to nitrites (ex: E.coli)
4. Pyuria (WBC) indicative of inflammation (including infection)
5. WBC casts - indicative of renal origin leukocytes

Question 14

what does WBC on a gram stain mean?

Answer 14

indicative of infection

Question 15

what do epithelial cells on a gram stain mean?

Answer 15

contamination

Question 16

what are coliforms?

Answer 16

part of normal intestinal flora of humans and animals that can be isolated from a variety of environmental sources

Question 17

what grousp can I isloate coliforms from?

Answer 17

escherichia
klebisella
enterobacter
serratia
citrobacter

• all are gram negative baccili

Question 18

what is a coagulase test (coagulase negative staphyloccocus)

Answer 18

differentiate S.aurea from this group (S. epidermis, s.saprophyticus, s.hemolticus)

relatively low virulence but often resistant to antibiotics

Question 19

when should we treat asymptomatic bacteremia?

Answer 19

-we don’t treat unless:

• pregnant
• before TURP or urological procedures where mucosal bleeding is anticipated
  -bacteremia persists fro 48 hours after removing cathether

Question 20

treatment of asymptomatic bacteriemia before and after invasive urological intervention

Answer 20

• aerobic gram-negative bacilli
• TMP-SMX for 3 days

Question 21

treatment of asymptomatic bacteriemia pregnancy and why

Answer 21

• increased risk of pyelonitis, preterm labor and low infant birthweight
• aerobic gram-neg bacilli and coagulare-negative Staph
• amoxicillin, clavulanic, cephalexin, fosfomycin
• duration for 3- 7 days

Question 22

what are some Symptoms of uncomplicated cystitis

Answer 22

• usual: dysuria, frequency, urgency, suprapubic pain
• delirium (elderly, rule out other causes)
• fever (uncommon, if present treat like pyelonephritis and get blood cultures_

Question 23

usual pathogens for uncomplicated cystitis

Answer 23

e.coli and entererobacteriases
coagulase-negative staph
enterococcus

Question 24

tx of uncomplicated cystsiis

Answer 24

first -line (problem with these is minimual tissue penetration)
- nitrofurantoin (5 days)
- fosfomycin (1 dose)

second-line
- TMP -SMX (3 days)
- Cipro (3days) ( this can cause lots of damge to flora of gut

Question 25

pregnancy uncomplicated cystitis

Answer 25

avoid Tmx-SMX in the start and towards the end

• avoid nitrofurantoin near-term
• do not use cipro
• treat for 7 days
• cefixime for 7 days

Question 26

Prphylaxis - when is it needed? what should we do befreo starting tx

Answer 26

when 3 or more episodes per year

pretreatment urine culture is recommended

Question 27

prophylaxis related to coitus

Answer 27

TMP-SMX
Nitrofuratoin

• both PO pericoitus

Question 28

prophylaxis unrelated to coitus

Answer 28

TMP - SMX ( 1 before bedtime, or 3 times a week for 6 months)

Trimethoprim (PO for 6 months)

Question 29

complicated UTI

Answer 29

functional or anatomical abnormality ( obstructive uropathy, recent instrumentation, delayed/ impaired voiding, metabolic abnormality, immunocompromised)

• males
• S and s siislar to usual
• can include systemic (fever, increased LKC, decreased BP)

Question 30

what increase risks of complicated UTI?

Answer 30

catheters

Question 31

when should we treat complicated uti and why?

Answer 31

only if UTI symptoms or systemic infection

b/c there is potential for abx misuse

Question 32

complicated uti afebrile, systemically well tx

Answer 32

cefixime, amox/clav, cipro, tmp-smx

Question 33

complicated uti febrile, systemically unwell tx

Answer 33

ampicillin
- gentmicin and ceftriaxone

Question 34

complicated uti hemodynamically unstable

Answer 34

pip/tazo
gentamicin

Question 35

duration of theroay for complicated uti

Answer 35

7-14 days

Question 36

what step dwon from IV to po should we consider

Answer 36

FQ or TMP-SMX