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Adult/Ped Medicine 6 > UTI - Brown > Flashcards

UTI - Brown Flashcards

1
Q

How many colonies on a culture indicate the presence of a UTI (microbiology definition)?
How many colonies in a symptomatic patient before you start treatment?

A 
100,000 org/ml (microbiology definition)
In patients with symptoms: 100-10,000 to begin treatment
multiple organism (3+) suggests contamination
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2
Q

Microbiology definition of UTI

A

100,000 org/ml.
Symptomatic: 100-10,000
Multiple organisms (3 or more) suggest contamination

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3
Q

Risk Factors for UTIs (8)

A

1) Gender
2) Sexual activity and contraception
3) Pregnancy
4) Obstruction
5) Neurogenic bladder dysfunction
6) Vesicoureteral reflux
7) Bacterial virulence factors
8) Immunosuppressed states: Sickle cell

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4
Q

Clinical symptoms of UTI:

A

Dysuria
Frequency
Urgency
Suprapubic pain/pressure

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5
Q

With complaints of vaginal discharge, the dx of a UTI Increases/ Decreases by 20%

A

Decreases- vaginal symptoms may be causing dysuria

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6
Q

Who needs a urine C&S?

A

1) Seriously ill pts
2) Recently hospitalized/ hospitalized pts
3) Men and all children
4) Women with relapse or reinfection
5) Women with complicating factors
6) Pregnancy

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7
Q

Etiology of UTI in women

A

1) E. coli (75-95%)
2) Enterobacter
3) Klebsiella
4) Proteus

  • Gram negative causes 90-95%
  • Gram + cause 5-10%
  • Staph saprophyticus cause 10-15%
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8
Q

What drug for UTIs could you use for prophylaxis

A

Trimethoprim: Bacteriostatic

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9
Q

Drug of choice for UTI

A

Trimethoprim-Sulfamethoxazole

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10
Q

What is a drug for UTIs active against G+ and G- bugs which is contraindicated in pts with GFR <60 but safe in early pregnancy

A

Nitrofurantoin

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11
Q

What can you use for UTIs but is not first line?

A

Cephalosporins, FQ (resistance, contraindicated in kids and pregnancy)

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12
Q

What is first line in UTI is resistance to TMP/SMX is >20%

A

Quinolone

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13
Q

Fosfomycin is only indicated in what type of UTI

A

Uncomplicated UTI

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14
Q

For symptomatic UTIs, normally how long do you treat?

A

3 days

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15
Q

Urinary analgesics:

A

1) Phenazopyridine (Pyridium) - turns urine orange, stains
2) Flavoxate (Uripas)
3) Cranberry Juice?

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16
Q

Safe drugs for UTIs in pregnancy:

A

1) Penicillins
2) Cephalosporins
3) Nitrofurantoin
4) Fosfomycin

17
Q

T/F: If a pregnant women is suspected of having pyelonephritis, what should you do?

A

Hospitalize

18
Q

Treatment for Pyelo outpatient

A

1) FQ or TMP-SMZ recommended
2) Amox or Augmentin ok if gram + bug
- 10-14 days

19
Q

DDX for Dysuria

A

1) Cystitis
2) Painful Bladder Syndrome
3) Vaginitis (Infectious, Chemical, PID)
4) Prostatitis
5) Urethritis
6) Meatal strictures

20
Q

T/F A UTI in a male patient is very rare and possibly pathologic and should undergo a work-up.

A

TRUE

UTI’s are very common in females.

21
Q

Protective Factors

A 
Long urethra
Bladder emptying
Antibacterial properties of urine
Prostatic secretions
PMNs in bladder wall
22
Q

UTI Urinalysis Findings

A 
Cloudy urine
Malodorous
Hematuria (microscopic)
Dipstick Results: nitrite (+) or leukocyte esterase (+)
Microscopic: WBC, Bacteria, casts
23
Q

UTI Physical Findings

A

Vitals - document temperature
Suprapubic Palpation
Palpation of CVA
Lab - get a urine sample

24
Q

__________ is the most common etiologic agent of UTI’s and what what is the drug of choice.

A

E. Coli

Trimethoprim-Sulfamethoxazole (TMP-SMZ)

25
Q

3 Drugs of Choice for Uncomplicated UTIs

A

Nitrofurantoin
TMP/SMX (depends on local resistance rates)
Fosfomycin

26
Q

Helpful Suggestions for Patients with UTIs

A

Drink plenty of water
Void frequently
Void after intercourse

27
Q

What is definition of recurrent UTI’s?

What can be used for prophylaxis?

A

3 documented UTIs/year

Prophylactic: Nitrofurantoin, Keflex, TMP-SMZ, Noroxin

28
Q

Most Common Etiology for Pyelonephritis

A 
E. coli
Proteus
Klebsiella
Enterobacter
Psuedomonas
29
Q

Clinical Findings in Pyelonephritis

A

Fever
Flank Pain
Shaking Chills
Voiding Symptoms: dysuria, frequency
Constitutional Symptoms: nausea, vomiting, diarrhea
Physical Exam: fever, tachycardia, +/- CVA tenderness

30
Q

What finding on microscopic urinalysis is a strong indicator of pyelonephritis?

A

WBC casts

31
Q

UTI Symptoms in Newborns and Infants

A

non-specific signs: fever, poor feeding, irritability, vomiting, sepsis, hypothermia

strong, foul-smelling odor

32
Q

UTI Symptoms in Preschool

A

abdominal or flank pain, vomiting, fever, frequency, dysuria, enuresis

33
Q

UTI Symptoms in School-Age Children

A

classic signs and symptoms but CVA tenderness is uncommon

Adult/Ped Medicine 6 (14 decks)

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