240 - UTI Flashcards Preview

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Flashcards in 240 - UTI Deck (27)
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1

What is the serious adverse effect associated with beta-lactams?

Allergy

Collateral damage to natural flora

2

What are the drug of choice for uncomplicated cystitis? (2)

TMP-SMX or Nitrofuantoin

3

Why might a patient have UTI symptoms but no bacteria on urinalysis or culture?

Bacteria can form a nidus in the bladder and live there without getting into the urine

 

Pts are considered infected with a UTI if they have consistent symptoms

4

List the indications for imaging in patients with UTI

  • Complicated UTI
  • Failure to respond after 3 days of therapy

 

NOTE: image after no response to therapy after 72h of therapy in UTI, or 5-6 days in pyelonephritis

 

 

5

List 3 symptoms commonly associated with acute pyelonephritis

Chills

Fever

Flank pain

6

What virulence factor is most important for bacterial adherence?

Pili

 

7

List 4 host factors that promote colonization of bacteria in the urinary tract

  • Sexual activity
    • Increases inoculation
  • Spermicide
    • Allows bacteria to bind
  • Estrogen binding
    • Allows bacteria to bind
  • Antimicrobials
    • Decrease indiginous flora, which exposes more receptors

 

8

What is the next step in management when a patient presents with symptoms of a UTI?

Urinalysis

(Can treat emperically before results come back, do not need to culture)

9

List 3 symptoms of cystitis

Dysuria

Urgency

Frequency

 

Cystitis = bladder infection; common type of UTI

10

Which bacteria is the most common cause of UTI?

E. coli

11

What is the difference between complicated and uncomplicated UTI?

  • Uncomplicated
    • Normal urinary tract
    • Usually people with female genitalia
    • People with normal male genitalia usually do not get UTIs
       
  • Complicated
    • Anormal urinary tract (in structure or function)
    • Any child and anybody with male genitalia who gets a UTI probably has a complicated UTI

 

 

12

How does the treatment of uncomplicated cystitis differ in reinfection vs. persistent infection?

  • Re-infection
    • Usually a longer interval, different bacteria
    • Manage medically with antibiotics
       
  • Persistent infection
    • Short interval, same bacteria
    • Image and treat surgically (remove potential nidus that is seeding infection)
    • If no imaging fingings, try low-dose prophylaxis for a long tiem

 

 

13

Which class of antibiotics is best for treating acute pyelonephritis in young women?

Fluroquinolone

14

Which patient group requires treatment for asymptomatic bacteruria?

Pregnant women

 

Do not treat asymptomatic bacteruria in anyone else!

15

Which of these drugs would you select for treatment in this situation?

Drug A - has the highest margin of error

 

(Want a drug that has urinary levels way above required MIC to kill the bug)

16

Describe the pathogenesis (Key early events) in UTI pathogenesis

  • Pathogenic bacteria stick to epithelial cells
  • Cells phagocytosed, immune system activated (cytokines), WBCs recruited
  • Bacteria work to try to block the cytokines so they can get some traction

 

17

What is the difference between complicated and uncomplicated pyelonephritis?

Obstruction = complicated

No obstruction = uncomplicated

18

What is the serious adverse effect associated with fluoroquinolones?

Tendonitis, allergy

Collateral damage to natural flora

19

What is the serious adverse effect associated with nitrofurantoin?

Pulmonary fibrosis

20

What is the adverse effect associated with Fosfomycin?

GI distress (Nausea, diarrhea)

21

Which drug used to treat UTI is safest during any phase of pregnancy?

Beta lactams

(Penicillins and cephalosporins)

22

Which antibiotic agents used to treat UTI are most likely to cause "collateral damage" by dirupting the normal urinary flora? (2)

Fluoroquinolones

Beta-lactams

 

23

What is the serious adverse effect associated with TMP-SMX?

Rash

(And Stevens-Johnson syndrome)

24

What is the most common cause of acute pyelonephritis in young women?

(Which pathogen)

P-piliated E. coli

25

Why does cranberry juice work to prevent UTI?

Contains mannose

Mannose prevents fimbriae and pili from sticking to cells of the urinary tract

 

In E. coli, Type 1 sticks to bladder, Type P sticks to urinary ract

26

In addition to antibiotics, what treatment should be considered for the management of a small perirenal abscess in a functioning kidney?

Percutaneous drainage

27

What is the appropriate managment of a complicated UTI?

Do imaging

Manage medically and/or surgically depending on findings